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A VISIT 

TO 

THIRTEEN ASYLUMS FOR THE INSANE 

IN 

EUROPE; 

TO WHICH ARE ADDED 
A BRIEF NOTICE 

OF 

SIMILAR INSTITUTIONS IN TRANSATLANTIC COUNTRIES 

AND IN THE 

UN ITED STATES, 

AND 

AN ESSAY 

ON THE 

CAUSES, DURATION, TERMINATION AND xMORAL TREATMENT 

OF 

INSANITY. 

WITH COPIOUS STATISTICS. 

BY PLINY E ABLE, M. D. 

Resident Physician of Friends' Asylum for the Insane, Frankford, near Philadelphia, Pa.; Honorary Member of the 

Philadelphia Medical Society; Member of the Botanical Society of Edinburgh, and Corresponding 

Member of the Medical Society of Athens, Greece. 



PHILADELPHIA 




J. DOBSON, 108 CHESTNUT STREET. 
1841. 



A VISIT, &c. 



THE MIDDLESEX COUNTY LUNATIC ASYLUM. 

The Lunatic Asylum for the paupers of the county of Mid- 
dlesex, Eng., is the largest institution of the kind in Great 
Britain. It is located at Hanwell, a few miles from London. 
It went into operation in 1831. The very extensive building 
is erected upon three sides of a square, or rather of an oblong 
space, which, being handsomely planted in the style of English 
gardens, forms a front yard of attractive beauty. The princi- 
pal part, or longest portion of the edifice, runs parallel to the 
road, which is, perhaps, one-eighth of a mile distant. The 
other two portions, as may be inferred from what is said above, 
run towards the road from the two extremities of the principal 
one. The three are of equal height and width. The central 
part of the principal one is expanded to a greater width, and 
is hexagonal in form. Within this are the offices and the 
apartments of the superintendents. A similar hexagonal por- 
tion exists in each of the other two, not, however, near the 
centre, but removed a short distance from their extremities. 
Large as was this edifice, it had proved inadequate to the ne- 
cessities of the county, and, at the time when I was there, 
extensive additions were in progress. These consisted of two 
wings, one near the extremity of each of the two portions 
running from the principal building, towards the road, attached 
to these portions on the external side, or that opposite the ob- 
long yard, and running at right angles to them. Hence they 
are parallel to the road and to the principal part of the build- 
ing. The stairs are in the hexagonal enlargements. The 
wards are divided into small rooms for dormitories, upon 
1* 



one side of a narrow gallery which runs from one extremity 
to the other. The cooking and the heating of the apart- 
ments, throughout the whole establishment, are performed by 
steam. The length of pipes for the last purpose is upwards of 
one and a half miles. The house is lighted by gas. The 
hours of meals are 8 o'clock, A. M. and 1 and 7 P. M. A 
quart of strong beer, per diem, is allowed to such of the pa- 
tients as labour, and a pint to the others. 

One of the most prominent characteristics in the internal 
economy of this institution, is the amount of labour performed 
by the inmates. But few Asylums of the kind can furnish so 
great a per centage of patients devoted to useful occupations. 
Of the six hundred who were there in 1837, more than four 
hundred were thus employed. Most of these were incurables. 
The cooking for all the residents at the Asylum, the brewing, 
washing, tailoring, shoemaking, and gasmaking, are all per- 
formed by the patients, there being, in each department, a 
sane person who acts as overseer. Carpentering, cabinet- 
making, the manufacture of straw hats and bonnets, the spin- 
ning of twine, basket-making, and picking, carding, and spin- 
ning wool for mops are also carried on to no inconsiderable 
extent. Many of the patients are employed in horticulture 
and other labour in the open air. In one year six of the pa- 
tients were taught the art of shoemaking. No accident has 
hitherto occurred from trusting edged and other dangerous 
tools in the hands of the employed. 

"On entering the gate," says Harriet Martineau, in describ- 
ing her visit to this Asylum, "I met a patient going to his 
garden work, with his tools in his hand; and passed three 
others breaking clods with their forks, and keeping near each 
other for the sake of being sociable. Further on were three 
women rolling the grass in company; one of whom, a merry 
creature, who clapped her hands at the sight of visitors, had 
been chained to her bed for seven years before she was brought 
hither, but is likely to give little further trouble henceforth, 
than that of finding enough for her to do. A very little suffices 
for the happiness of one on whom seven years of gratuitous 
misery have been inflicted: — a promise from Mrs. Ellis to 



shake hands with her, when she has washed her hands; a 
summons to assist in carrying dinner; a permission to help to 
beautify the garden, are enough. Further on, is another in a 
quieter state of content, always calling to mind the strawber- 
ries and cream Mrs. Ellis set before the inmates on the lawn 
last year, and persuading herself that the strawberries could 
not grow, nor the garden get on, without her, and fiddle-fad- 
dlinsr in the sunshine to her own satisfaction, and that of her 
guardians. This woman had been in a strait waistcoat for 
ten years before she went to Hanwell. In a shed in the gar- 
den, sit three or four patients cutting potatoes for seed, singing 
and amusing each other; while Thomas, a mild, contented 
looking patient, passes by with Mrs. Ellis's clogs, which he 
stoops to tie on with all possible politeness; finding it much 
pleasanter, as Dr. Ellis says, Ho wait on a lady than be chained 
in a cell.' In the bakehouse, meanwhile, are a company of 
patients kneading their dough; and in the wash-house and 
laundry many more equally busy, who would be tearing their 
clothes to pieces if there was not the mangle to be turned, and 
a prodigious array of linen in the drying closet to be ironed. 
A story higher are coteries of straw-plaiters, and basket-makers, 
and knitters among the women, and saddlers, shoemakers and 
tailors among the men."* 

A chapel is connected with the institution, where a portion 
of the patients assemble at a weekly service, and at morning 
and evening prayers. Those patients who leave the Asylum 
destitute of pecuniary means are, by a beneficent provision of 
the government of the institution, so far assisted as to enable 
them to supply their wants, until they can obtain a situation 
wherein to gain a subsistence. 

Sir W. C. Ellis, who, in 1837, and for several years pre- 
viously, had fulfilled the duties of superintendent of this 
Asylum, has published a work upon insanity, from which 
the following anecdote is extracted. It proves that he is 
gifted with a presence of mind, and a sagacity adapted to any 
emergenc}^, and worthy of the man who has received the dis- 

* Miscellanies, by Harriet Martineau. Boston edition. Vol. i. p. 231. 232. 



8 

tinguished honour of knighthood, in consideration of his skill 
in the management of the insane. 

A workman at the Wakefield Lunatic Asylum left a chisel 
more than three feet long in one of the wards; a furious pa- 
tient seized it and threatened to kill any one who approached 
him. Every one then in the ward immediately retreated from 
it. "At length," says the author referred to, "I opened the 
door, and, balancing the key of the ward on my hand, w^ked 
slowly towards him, looking intently at it. His attention was 
immediately attracted; he came towards me, and inquired 
what I was doing. I told him I was trying to balance the 
key, and said, at the same time, that he could not balance the 
chisel in the same way on the back of his hand. He imme- 
diately placed it there, and extending his hand with the chisel 
on it, I took it off very quietly, and without making any com- 
ment upon it. Though he seemed a little chagrined at having 
lost his weapon, he made no attempt to regain it, and, in a 
short time, the irritation passed away." 

This accomplished physician, (Sir William C. Ellis) is now 
(1S40) deceased, and the Asylum is under the superintendence 
of Dr. Conolly, the author of a valuable treatise upon insanity. 
The new wings have been completed, making, in all, accommo- 
dations for 850 patients. 

For the opposite engraving of the ground plan of the Asy- 
lum, I am indebted to Frederick A. Packard, Esq. 




a Bake-house. 

Brew-house. 

Gas-house. 

Steam-boilers. &c. 
b Kitchen and Scullery. 
c Coal sheds. 

d Cart-house, stable and shed. 
e Superintendent's stable. 
/ Gardener's house. 
g Cow-house. 

h Wash-house, drying-rooms, laun- 
dries. 
i Engine-house, and Engineer's shop. 
j Superintendent's garden. 
k Garden. 



I Airing Court; 

m Well. 

n Carriage road. 

o Cultivated grounds. 

p Burial ground. 

q Canal. 

r River. 

5 Road. 

t Lodge. 

u Entrance. 

v Farm yard. 

10 Dock. 

x Male side. 

y Female side. 



10 



THE PAUPER LUNATIC ASYLUM FOR THE WEST RIDING OF YORK, 
AT WAKEFIELD. 

This, like the Asylum just treated upon, is one of a great 
number of establishments erected in various counties through- 
out England, for the reception and treatment of those unfor- 
tunate people who, drinking a twofold portion of the cup of 
affliction, are suffering under both abject poverty and mental 
alienation. It was established in the year 1816, and opened 
in Nov. 1818. Its whole original cost, including a farm of 
twenty-five acres, was eleven thousand pounds sterling. Ex- 
tensive additions have since been made. It is pleasantly situ- 
ated, about a mile from the town of Wakefield, and, when 
approaching it, is nearly hidden from view by the shrubbery 
and trees with which it is environed. The original form of 
the ground plan of the building was that of the letter H. At 
either of the two points represented by the junction of the 
horizontal with the upright portions of the letter, there is an 
expansion of a circular form, constituting a kind of tower. 
Within these, and leading to the uppermost story, are spiral stair- 
cases, at the side of which there are windows communicating 
with the wards. Hence two persons, one upon each flight of 
stairs, can, with very little labour, oversee all the patients 
while they are in the wards. The wards, unlike those of 
some of the American Asylums, have dormitories upon but 
one side, the remaining space being occupied by a gallery. 
The bedsteads, like those of most public institutions in Eng- 
land and France, are composed of iron. The establishment 
is lighted throughout by gas, which, as well as the beer, 
bread, shoes, clothes, and cloth for external garments con- 
sumed by the patients, are manufactured upon the premises, 
and, principally, by the insane themselves. The medical 
superintendent, to whom all other persons in the house are 
subordinate, acts as secretary, treasurer, steward, surgeon and 
apothecary, and, in concert with the matron, has the general 
direction of the treatment of the patients, the domestic arrange- 
ments, &c. &c. In the medical department, however, he is 



11 

subject to the visiting physician. Besides other records, he 
keeps a diary of casualties, or remarkable circumstances, and a 
medical journal, in which he places a history of every case 
admitted to the Asylum. He is obliged to visit all the wards 
and see every patient at least once every day, and oftener if 
necessary. He carries a master-key to the wards and outer 
doors, and these are secured every night by himself, personally. 
The matron, who has a salary of 100/. sterling per annum, 
is subject to the director or medical superintendent, and, so far 
as their duties are similar in the two departments, is governed 
by the same rules and regulations. Aside from her duties to 
the patients, she has charge of the kitchen and of the neatness 
and propriety of the whole house. She is required to see 
every room and every female patient as often as once each 
day, and to secure all the doors in the female department at 9 
o'clock, P. M., from the 1st of October to the 1st of April, 
and at 10 o'clock during the remainder of the year. 

As many of the patients as possible are employed as servants, 
and the hiring and dismissal of other domestics is entrusted to 
the director. The cause of dismissal, when such cases occur, 
is always registered. The following extracts are from the 
"Rules and regulations for the management" of the Asylum. 

"Any officer or servant found making a perquisite of any 
kind whatever, will be instantly dismissed." 

"Any servant striking a patient, will be instantly dismissed." 
"It is now known, by actual experiment, both at the Retreat 
and the Asylum at York, that much work of various kinds 
may be done by patients, not only to the great profit of the 
institution, but also to their very great advantage, both in body 
and mind; therefore, the director and matron will consider that 
they will not give satisfaction unless they have considerable 
success in this department of their duty." 

Furthermore, in respect to officers and servants, if any one 
of them take any present, or gratuity, from any tradesman 
dealing with the Asylum, or from any patient or visitor, he is 
discharged. Any servant found intoxicated, or who has been 
known to sell anything to one of the patients, without the 
knowledge of the director, is reprimanded for the first offence 
and dismissed for the second. 



12 

The number of patients in the Asylum during the summer 
of 1S37, was 334, of whom a small minority were women. 
Fifty or sixty of the men labour, regularly, either in the manu- 
facture of the articles above mentioned, in gardening, or in 
some mechanical trade. All the utensils used by the patients 
at their meals, unless necessarily metallic, are made of wood. 
The working patients are furnished, besides their regular meals, 
with two "drinkings" during the day, each of them consisting 
of three-fourths of a pint of beer and four ounces of bread. 
Nearly two hundred dollars per annum is paid for tobacco, 
which is also divided among the labourers, each being entitled 
to a weekly ration of one ounce. Many of the patients, as we 
jDassed through the wards, begged us for tobacco, or for money 
to purchase it with. One of them, after having thus played 
the mendicant, put into our hands a piece of cloth, upon one 
side of which he had written, in large letters, "Millennium. 
Green, blue and yellow united. " And upon the other, " Vic- 
toria 1st, July 28th, 1S37. Virgin Queen of Peace. Amen. 
Aquila." It will be perceived from the date, that this was 
but a short time subsequent to the accession of Victoria to the 
throne of Great Britain. The universal popularity which the 
youthful queen enjoyed, at that time, among her sane subjects, 
seems to have been participated also by some of those who 
were insane. And this poor, infatuated maniac beheld the 
"green, blue and yellow," the insignia of the different political 
parties of the realm, united through her means, and hence the 
"consummation devoutly to be wished/ 7 the immediate advent 
of the millennium! "Eh, eh/ 7 said he, after I had read the 
above, and, as he spoke, he looked up into my face with a 
piercing glance and a most significant smile, "do you know 
what Aquila signifies in English?" Being answered in the 
affirmative, "Well, sir," he continued, "I am the eagle," and 
he placed a most emphatic stress upon the pronoun, in order 
to give us an adequate idea of the dignity of his person. 

Food. — The food is furnished by contracts, of three months 
each, which are made between the visiting justices and the 
contra tors on the first Monday in January, April, July and 
October. The contractors for meat, bread, &c, at the time of 



13 

the delivery of one parcel, take an order for the next. The 
meat and bread are delivered twice a week, on Wednesdays 
and Saturdays. For breakfast and supper the patients are 
furnished with a kind of pudding, made of the following ma- 
terials, and in the proportions annexed, viz. — Milk, 1 gallon; 
water, 2 gallons; oatmeal, 2f lbs. ; wheat flour, i lb. For din- 
ner, "Yeast dumplings with treacle sauce, and boiled beef or 
mutton with vegetables, on Sundays, Tuesdays and Thursdays; 
6 ounces of meat, free from bone, allowed to each patient." On 
Mondays, Wednesdays and Fridays, a soup made from the meat 
boiled on the previous days, and on Saturdays, beef-pie or Irish 
stew. Fifteen ounces of bread per day is allowed to each person, 
and milk is furnished them, "as required," not exceeding one 
pint each per diem. The hours of meals are 8% o'clock, A. M., 
and 1 and 7 o'clock, P. M., throughout the year. 

The women were supping when we went through their de- 
partment, each eating her ration from a small wooden dish, 
similar to a pail. That air of neatness and comfort which 
reigns throughout the establishment is particularly conspicuous 
in the section for the females. One of the women, who had 
been refractory, had her arms confined. We had previously 
observed, in the men's department, that confinement by straps 
in chairs and beds, is also resorted to in cases of violent mania. 

"Who are you?" inquired one of the women who were 
eating, after havfng scrutinized me with the wild and search- 
ing gaze of a maniac, "are you a Methodist minister?" "No," 
said I, "I am an American. " This answer was perfectly 
satisfactory, and no sooner was it uttered than half a dozen 
patients suddenly rose, "0, you are from America; then you 
know my brother," said one. "Do you know J. F.?" in- 
quired a second. "Have you ever seen ?" asked a 

third; "he is my husband's brother." "I have a sister in 
America," remarked a young woman, looking up with a smile 
so gentle and an expression of countenance so calm and sub- 
dued, that one beheld in it more of the attractive innocence 
and beauty of sane and healthy childhood, than the fierceness 
and wildness of confirmed lunacy. 

The number of patients admitted to treatment in this Asy- 
2 



OA.k*WJ;J &* c \* 



14 



lum, from the time it commenced operation, Nov. 23d, 1818, 
to January 1st, 1837, was 2242, viz. 

Males. 

1150 

Of whom there have died, 420 

u " been discharged, 560 

" " are remaining, 170 

The total number of cures was 991, equivalent to 44^ per cent. 
The number relieved, but not cured, was 233. The deaths 
are equivalent to 31 T 6 ^ per cent. The admissions have ave- 
raged, for a few years past, between 140 and 150 per year. 

The following table exhibits the ages at which all the pa- 
tients were admitted: — 



Females. 


Total. 


. 1092 . 


. 2242 


. 289 . 


. 709 


. 664 . 


. 1224 


. 139 . 


. 309 





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fa 


fa 


fa 


;=. 


fa 


fa 


fa 


fa 


E- 


Males, 


56 


282 


303 


285 


127 


74 


18 


5 


1150 


Females, 


51 


232 


324 


270 


128 


71 


13 


3 


1092 


Total, 


107 


514 


627 


555 


255 


145 


31 


8 


2242 



By this, it will be perceived that the number received be- 
tween 20 and 30 years of age is less than that of those between 
30 and 40, or even those between 40 and 50. The number 
between 30 and 40 is considerably larger than either of the 
others. It is greatly to be regretted that the ages of the at- 
tacks, instead of those of entrance to the Asylum, could not 
have been preserved. Had this been the case, the number of 
those between 20 and 30, and 30 and 40, would probably both 
have been larger, the former certainly so, while all those of a 
greater age would have been reduced. 

The annexed table exhibits the results of treatment in refer- 
ence to the stage of the disease, or its term of duration. 



15 






2d. 
3d. 



382 
212 



163 
149 



1st. Within 3 months of the first 

attack, . . C82 

a 12 " u 409 

Between 1 and 30 years from 

the first attack, . . 516 5S 265 

4th. Those who had previously^ 

been insane and confined > 2SS' 

in this Asylum, ) 

5th. Those who had previously ) 

been insane but not treat- > 347 

ed in this Asylum, ) 



339 132 



233 



V309 



Total, 2242 991 709 233 309 

Of the 1st division there were cured, 56.01 per cent., and 22.9 
per cent, died: of the 2d division 51. S3 per cent, were cured, 
and 36.43 per cent, died; of the 3d, 11.2 per cent, were cured, 
and 51.35 per cent, died; of the 4th and 5th included together, 
53.38 per cent, were cured, and 20.79 per cent. died. 

By an examination of these results, we have another evi- 
dence of the utility of treatment during the acute stage of in- 
sanity. 

THE RETREAT NEAR YORK. 



Perhaps the remarks to be made upon this Asylum cannot 
be given more suitably than in an extract from a letter, written 
to a correspondent while I was in York, in 1837. 

"Soon after dinner, on the day of my arrival in this city, a 
son of Samuel Tuke called at the hotel, with an invitation from 
his father for me to make a home at his house during my stay 
in York. This- politely proffered hospitality was accepted, 
and I shall ever remember with pleasure the hours which I 
have spent beneath this roof, in the society of an intellectual 
and intelligent family. S. Tuke is well known in this country, 
as well as in the United States, by those interested in the 
treatment of lunatics, for the attention which he has devoted 



16 

to the subject, and the essays connected with it which have 
emanated from his pen. It is probable that no other man 
living, without the pale of the medical profession, is so well 
acquainted with the proper management of the insane, and the 
most suitable construction, arrangement and discipline of luna- 
tic asylums. His father was the projector of the Retreat, an 
institution of the kind near York, which, under the auspices of 
the son, and others, has attained a high reputation. This Asylum 
was one of the pioneers in that great and important revolution 
which has taken place in the moral treatment of the insane. 
'The Retreat near York' has long been quoted in the United 
States, as approaching nearer to perfection in its management, 
and as giving a higher per centage of cures than any other 
public establishment in England. It was established by mem- 
bers of the society of Friends, the funds being obtained by 
annuities, donations and annual subscriptions. The original 
cost was 5970 pounds, IS shillings, 10 pence, sterling, includ- 
ing the expense of eleven acres of ground, which constitutes the 
farm. The receipts from patients were inadequate to defray 
the current expenses, for several years after the institution went 
into operation. Our countryman, Lindley Murray, was an 
early and active promoter of the interests of this establishment. 
"I breakfasted yesterday with Dr. W , and, subse- 
quently, he accompanied me to the Asylum. The superin- 
tendent conducted us through the several departments. The 
buildings are, perhaps, less convenient than those of some 
other similar institutions, inasmuch as, having been at first 
small, they have been several times altered and enlarged, ac- 
cording to the increasing necessity for additional accommoda- 
tion. To the wings, hitherto but two stories in height, an 
additional story is now in progress of erection. Originally 
intended for but thirty, the buildings, after the completion of 
the present improvements, will furnish ample room for one 
hundred and twenty patients. The classification of the insane 
is founded, principally, upon their ability or willingness to 
pay for the accommodations afforded. There are four classes, 
in the lowest of which the price is fixed at four shillings, 
sterling, per week, while in the highest it varies from about 



17 

twenty to eighty shillings. Those who pay the price last 
mentioned have two rooms, elegantly furnished, and a special 
attendant. System and neatness prevail in every depart- 
ment, and elegance is added to that of the class last men- 
tioned. The courts, or yards, occupied by the patients when 
out of doors, correspond with the rooms within. That 
belonging to the highest class of men is a lawn, gently sloping 
southwardly, surrounded by trees and hedges, and bordered 
with a diversity of flowers, the profuse blossoms of the rose 
predominating at the present time. In this court there were 
several patients, either reading in the shade or amusing them- 
selves with the flowers. In cooking, steam is used to a con- 
siderable extent; and, as we passed through the kitchen, we 
perceived that instrument of olden days, a smoke-jack, turning 
no less than four spits, liberally supplied with meat. 

"It appears to have been the aim of those who have had the 
direction of this institution, to make the place a home to each 
patient. Hence the expense devoted in improving the grounds 
and the apartments, and hence, also, the introduction of amuse- 
ments7;judiciously Selected, and the encouragement of reading 
and of labour. S. Tuke believes that labour, properly pursued, 
is the most efficient auxiliary in effecting a cure, and acknow- 
ledges the superiority of the treatment at the Asylum at Sieg- 
berg, on the banks of the Rhine, over all others, principally 
from their having succeeded in inducing, not compelling, the 
wealthy patients to labour. In England, as in the United 
States, the officers of the Lunatic Asylums complain of negli- 
gence on the part of the friends of insane persons, in omitting 
to place them under their care until the disorder has assumed 
a chronic character, and, consequently, the probability of a 
cure exceedingly diminished. In order, if possible, to remedy 
this evil, fraught, as it is, with consequences of so fearful a 
nature to the unfortunate sufferers, the directors of the Retreat 
have ordered that an abatement of four shillings per week 
during the first year of the patient's residence in the Asylum, 
be made from the expenses of those who enter within six 
months of the first decisive symptoms of the dreadful malady." 

From the report of the Retreat for 1S37, we learn that, 
2 



18 

since its foundation, 508 insane persons have partaken of its 
benefits. Of this number 245 were men, and 263 women: 85 
of the former and 95 of the latter had been married, but some 
of them were widowers and widows. 

The following table exhibits the result of the treatment of 
the whole number, down to the time of making the report: — 



<y 



S 5 



<i rt § S O £ tf 
Of 1st attack, and less than} qq 71 1 4 12 1 

three months duration, $ 
Of 1st attack, and from three, 1Q7 47 7 6 20 4 g; 

to twelve months duration, 



Less than 12 months dura- 
tion, but not the 1st attack, 

More than twelve months £ 2Q , 
duration, 5 



in 66 4 6 15 6 14 
52 4 18 66 13 48 



Total, 508 236 16 34 113 23 86 

Besides the results immediately evident by the table, it will 
be found, by calculation, that the cures of those in the upper- 
most line, or those of the first attack and admitted within 
three months of its commencement, are equal to 79.7 per 
cent; of those between 3 and 12 months, 43.9 per cent.; of 
those of the second attack, and whose disease was of less than 
12 months duration, 59.4 per cent.; and of those of more than 
12 months duration, 25.8 per cent. The cures of the whole 
equal 46.5 per cent., and the deaths 22.2 per cent. 

The following table, showing the ages of those who died, 
may be useful in ascertaining the comparative length of life in 
maniacs and the sane. 



Under 
30 years. 




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Males, 5 


8 


5 


15 


10 


6 


6 


1 


56 


Females, 6 


4 


10 


8 


16 


8 


4 


1 


57 


Total, 11 


12 


15 


23 


26 


14 


10 


2 


113 



19 

The next table gives the ages at which 89 of the patients 
were first attacked with the malady for which they were con- 
fined. As such it is very valuable; and it is to be regretted 
that the same data could not have been ascertained and pre- 
served in regard to a greater number. 



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fe S3 C S3 S3 S3 S3 S3 G S3 S3 S3 S3 
— > C3 C3 C3 Ci d c3 03 C3 03 C3 C3 tf 

8 17 18 13 12 4 5 2 3 2 4 1 89 
It has already been remarked that amusements and labour 
have been introduced into this institution, as curative means. 
Of the former, however, there is not so great a variety as in 
some other Asylums, and a difficulty exists in applying the 
latter to so great an extent as would be desirable, from the fact 
that there is a large proportion of the patients, who, from their 
previous station in society are unaccustomed to manual labour, 
and consequently indisposed to it. 

YORK LUNATIC ASYLUM. 

In the suburbs of the city of York, in a direction nearly 
opposite to that of the Retreat, and not far from Bootham Gate, 
stands the York Lunatic Asylum. It is approached through 
an avenue, nearly a quarter of a mile in length, and thickly 
shadowed by lime trees. 

This institution was established in 1777, the necessary funds 
having been raised by voluntary subscription. It was intended 
for the insane, both paupers and others, within the limits of 
the county in which it is situated. In some instances, however, 
when peculiar circumstances render it desirable, those from 
other counties are received. From the nature of this institu- 
tion all patients are obliged to pay for their accommodation. 
The expenses of the paupers, of whom there is a considera- 
ble number, are defrayed by the parishes to which they seve- 
rally belong. The price varies from 6 shillings to 2/. sterling 
per week. Parish paupers of the county of York pay 6 
shillings, those of other counties, 7 shillings. Other indigent 
persons pay according to their circumstances. By paying 3 



20 

guineas per week, a patient is permitted to bring his own ser- 
vant to the Asylum. In this case the board of the servant is 
an extra expense. 

The principal edifice is of brick, consisting of a central por- 
tion and two wings. Another building, affording additional 
accommodations, stands adjacent to this and nearly in the rear 
of its westerly wing. The courts or yards are all spacious, 
and those occupied by the highest classes of patients are 
well cultivated, being handsomely planted with shrubbery 
and flowers. The number of insane in the Asylum, in the 
summer of 1837, was 170. There are accommodations for 
200. The patients are divided, as in the Retreat, into four 
classes, the principle forming the basis of classification being 
the same as at that Asylum. Among the amusements per- 
mitted are cards and billiards. Several groups of patients 
were engaged in playing with the former, at the time I passed 
through the wards. The strait jacket, the "refractory chair" 
— (into which a patient may be fastened by a strap passing 
around his body) — and muffs, for the confinement of the hands, 
are among the resources for punishment or coercion. 

The number of patients admitted into this Asylum, from the 
time of its going into operation, in November, 1777, to Octo- 
ber 10th, 1814, was 2635. Of these there were discharged, 
either cured, improved, or at the request of friends and guar- 
dians, 2133. Of the remainder, 399 died, and 103 remained 
in the Asylum at the latter date. The deaths during this 
period were equal to 16.8 per cent. Again, from October 
10th, 1814, to June 1st, 1837, a period of 22 years 4^ months, 
there were 1131 admissions, which, together with the 103 re- 
maining at the former date, makes a total of 1234. Of these 
there were 387 cured, 224 improved, 247 removed by their 
friends, and 217 deceased. There were remaining in the 
Asylum, at the date last mentioned, 83 men and 76 women, a 
total of 159. Excluding this 159, as being still under treat- 
ment, we have for the cures 36 per cent., and for the deaths 20 
per cent. 

The officers of the York Asylum are a physician, a chaplain, 
a treasurer, an apothecary, a steward, a house steward, and a 



21 

matron. The steward acts as secretary, keeps the minutes of 
the courts or meetings of the governors, the lists of admissions, 
removals, deaths, &c, and an inventory of the property in 
possession of the patients when admitted. He sees to supply- 
ing clothes, pays the bills for goods used in the house, and for 
the special use of patients. The institution is under the care of 
a number of officers, called governors. They consist of all the 
benefactors of the Asylum to the amount of 20/. and upwards, 
besides the Lord Mayor of York and one or two other ex-officio 
members. The governors hold five meetings, or, as they are 
technically termed, "courts," during each year. Special meet- 
ings may also be called. A committee appointed by the go- 
vernors hold monthly sessions for the purpose of auditing 
accounts, contracting for supplies, &c. &c. No officer resident 
at the Asylum is eligible to a place in this committee. There 
are two visiting governors for each month in the year, and 
three ladies, having similar duties, and appointed by the go- 
vernors, for each quarter. 

The physician, who does not reside at the Asylum, is 
required to visit the patients, regularly, three times a week, 
independently of those times in which some special case 
requires his attention. Divine service is performed every 
Sabbath, by the chaplain; and if those patients whose state of 
health does not admit of their attendance, should desire it, the 
chaplain is required to visit them in their wards at least twice 
a week, provided they are in a suitable state of mind. The 
apothecary resides in the house. It is his duty to oversee the 
attendants, to visit every patient twice during each day, to 
keep a history of all the cases admitted, to decide when and in 
what manner coercion shall be used, together with such other 
duties as generally belong to an officer of this kind. 

Any servant who strikes or otherwise maltreats a patient is 
dismissed. If a patient escape, the expense of retaking him is 
defrayed, either wholly or in part, at the discretion of the 
committee, by the servant having charge of him. No officer 
or servant is allowed to receive any fee or gratuity, other than 
the regular salary. 

The friends and medical attendant of each patient admitted 



22 

to the York Asylum receive the following questions, to which 
they are requested to give as correct answers as possible: — "Is 
this the first attack? If not, how many previous ones, and at 
what distance of time from each other? How long since the 
commencement of the present one? Has any, and what change 
taken place in the symptoms? Is there, or has there appeared, 
a disposition to self-destruction? or to injure others? or to de- 
stroy clothes? What defect, impropriety, or false notion marks 
the disease? What circumstance appears to have been the 
exciting cause? Was there any previous singularity or weak- 
ness? Is it known that any of the patient's relations have 
been in any degree deranged? What was the patient's natural 
temper? Favourite pursuits? Habits as to temperance? Of 
what religious profession? Have any, and what, medical 
means been employed? Is the patient subject to fits? or la- 
bouring under any bodily disease? Has the patient had the 
small-pox? or the vaccine disease?" 

ASYLUM AT AMSTERDAM. 

The city of Amsterdam, famous for its large number of 
charitable institutions, is supplied with two extensive civil 
hospitals, one of them in a central part of the town, the other, 
half a mile distant from its southern limits. Connected with 
the latter, or rather constituting a portion of it, there is an 
Asylum for the insane. A gentleman to whom I carried 
letters of introduction, having obtained, from the proper 
authorities, permission to visit that institution, accompanied 
me to it. The resident physician, a young man of enlarged 
intelligence and of great enthusiasm in the profession of which 
he is a member, conducted us through the several depart- 
ments. The building is of somewhat antique construction. 
Each ward, like those of most hospitals for the sick, is without 
subdividing partitions, the beds being arranged upon either 
side, and, in this instance, rather too compactly. The wards 
are, moreover, like those in the hospitals for the sick in Am- 
sterdam, in that they are two stories in height, a platform, or 
gallery, running around, above the beds, between the first and 



23 

the second story. This is used as a place of promenade for 
the patients. There are seven wards, four for women and 
three for men. The courts devoted to the use of the patients, 
and of which there is but one for each sex, are very small, and 
being without shrubbery, flowers, or even green-sward, have 
the naked and forbidding aspect of a prison-yard. Natives of 
the city of Amsterdam, alone, are admitted into this Asylum. 
The patients are mostly paupers, or subjects of charity. There 
are six beds, in small, decently furnished rooms, which are 
intended for pay patients. The number of patients, in July, 
1838, was 157. Of these 69 were men, and 8S women. A 
large majority of them were incurable. No less than 45 of 
the women were epileptics. One of the men has been in the 
Asylum ever since the year 1793. During the two years and 
eight months ending in July, 1838, there had been admitted 
85 men and 78 women, or a total of 163. In the same period, 
27 men and 29 women had been cured, and 40 men and 37 
women had died. As means of coercion and punishment, the 
hands and feet of patients are sometimes fastened, and the 
camisole, the strait-jacket and imprisonment are resorted to. 
For the last mentioned purpose there are six dungeons, con- 
structed three upon either side of a small apartment. One of 
these was occupied, at the time of my visit, by a woman, who 
was naked, raving and filthy. 

But little, indeed nothing, can be said in commendation of 
this Asylum. Time, perhaps, has been, in which it ranked 
among the most comfortable, and the most judiciously manag- 
ed institutions of the kind in the worlds but it has so long 
remained stationary, that others have far outstripped it in the 
rapid march of improvement which has characterized the last 
half century. The resident physician of the place is fully 
aware of its deficiencies, and is endeavouring to effect a change. 
In fact, the city government has already promised radical 
reform. The most glaring defects, at present, are, an insuffi- 
ciency of room within doors, as well as without; a want of 
cleanliness, particularly in the men's wards, and an almost 
entire absence of either labour or amusements. A few of the 
women were either knitting or sewing, but the men, without 



24 

exception, were unoccupied, lying on the floor, the ground, or 
the beds, standing in the stupidity of dementia and idiocy, or 
walking to and fro, raving with the unbridled fury of mad- 
men. There was about the place an air of most indescribable 
melancholy. How different from many a scene which I had 
witnessed in similar institutions in Great Britain, France, and 
the United States — institutions in which commodious apart- 
ments, thorough ventilation, and a scrupulous regard to per- 
sonal cleanliness, conduce to the physical health of the patients, 
in which judicious amusements win the wandering mind to its 
wonted path, and appropriate labour tends to calm the disturb- 
ed and agitated intellect. 

ASYLUM AT UTRECHT. 

I had a letter of introduction to Professor Vander Hoik, of 
the University at Utrecht, the principal physician of this hos- 
pital; but he was absent in the country. M. J. J. Vander 
Hagen Vander Heuvel, one of the agents, had the kindness, 
however, to accompany me to the Asylum and through its 
several departments. From the specimen of Dutch institu- 
tions of the kind which I had seen in Amsterdam, I confess 
that my expectations in regard to this were not very exalted. 
Besides, while we were on our way to it, M. Vander Heuvel 
took the opportunity to speak of its defects, saying that not 
much had been done by way of improvement, that much re- 
mained to be done, and that, to one who had seen the Asy- 
lums of other countries, this could present nothing of inter- 
est. Thus prepared, thus prejudiced, we entered the Asylum 
and gave it a pretty thorough examination. And it is but jus- 
tice to say, that in no other institution have I seen greater 
neatness, more apparent order, or the evidence of a more en- 
lightened and rational mode of treatment. 

This Asylum was formerly a private establishment, founded 
in the 15th century. It continued in existence, still pur- 
suing the old method of treatment and of discipline, until the 
year 1830. In that memorable year of revolutions the spirit 
of reform crept into this institution, effected a radical change, 



25 

and is still continuing the march of improvement. The build- 
ing, though still comparatively small, has been enlarged; the 
courts have been planted with trees and flowers, and, at the 
time of my visit, in July, 1838, their size was being much in- 
creased by extending their limits over the sites of some an- 
cient buildings, purchased by the "Regents" of the Asylum, 
and demolished by their order. The building is shaped like 
the letter L. The room of the superintendent is in the angle, 
in the second story, so situated that he can see every patient 
who is out of doors. The wards have dormitories on but 
one side, the remaining space being a gallery, which is used 
as a place of promenade in bad weather. The bedsteads 
for the most maniacal patients, and such as are not the most 
cleanly, are somewhat different from any. others which I 
recollect to have seen. They are made of boards, in the form 
of a child's crib, though deeper, and the bottom is concave or 
descends in every direction to the centre, where there is an 
aperture for the escape of water. There is a common sitting 
room for each class of the inmates. The number of patients, 
at the date just mentioned, was 94, that of the two sexes being 
about equal. They are divided into three classes, the basis of 
division being the sum paid for entertainment. Those of the 
first class pay S12 florins, equal to about 125 dollars, per 
annum; those of the second, 412 florins or 165 dollars; and 
those of the third, 100 and 150 florins. The third class is 
composed of paupers. Their clothing is included in the sum 
mentioned. Those who pay but 100 florins are natives of 
Utrecht; those who pay 150 come from other places. The 
rooms of the first class are furnished handsomely, but not with 
that elegance which is seen in those of the similar classes in 
some Asylums. 

When necessary, the camisole or the strait-jacket, fetters, 
the douche and the dungeon are put in requisition as means of 
punishment. The stream of water forming the douche is but 
one-fourth of an inch in diameter, while those of Salpetriere 
and Bicetre, at Paris, are about seven-eighths of an inch. 
The quantity of water flowing from the latter must, conse- 
quently, be nearly twelve times as great as from the former. 
3 



26 

There is but one bathing tub belonging to the establishment, 
but the accommodations in this respect are about to be in- 
creased. The patients resort to reading, writing, drawing, 
music, cards, billiards, chequers or draughts, and some other 
games, for amusement. There is a library intended for their 
use. The billiard table, a large and handsome one, was made 
by two of the former patients. In one of the men's rooms 
several patients were occupied in drawing and reading; and, 
had it not been for the wildness of the eye, and the character- 
istic traits of countenance, which cannot be mistaken, in one 
or two others who were present, I could hardly have believed 
myself to be in a mad-house. Most of the men in the first 
class were in the court devoted to their use. Among them 
was a physician. He conversed freely upon his situation, 
gave an account of his commencement of practice, and the 
success which attended his efforts, until his friends thought it 
best for him to take lodgings in the lunatic Asylum. At 
length he asked me if I thought him deranged. He had talked 
so rationally, and this question was put so directly and so 
earnestly, that to avoid answering it was almost impossible. 
An evasive reply, if any, must be given. "It is difficult to 
define derangement," said I; "and, if we should accept the 
definition given by some authors, we should include almost 
the majority of mankind." He appeared satisfied with the 
answer, and only remarked, with a melancholy tone, "Je crois 
Men que le plupart des gens sont des alienes." Poor man! 
although reason was dethroned, it was evident, from his con- 
versation, that the affections retained their empire. 

Some of the women were employed in sewing, knitting and 
house-work; some of the men in carpentry, shoemaking and 
tilling the garden. No accident has hitherto occurred from 
the use of edge tools by the patients. 

The following are the statistics of the entrances, cures, 
deaths, &c. from 1832 to 1837, inclusive:— 



27 



Date. 
1832 


Entered. 
22 


Cured. 
10 


Died. 
3 


Disch'd not 
improved. 


Per cent, 
of cures. 
45.45 


Per cent. 

of deaths. 

13.63 


1S33 


44 


14 


6 


2 


31.81 


13.63 


1834 


41 


16 


13 


7 


39.02 


31.70 


1835 


53 


18 


11 


6 


33.96 


20.75 


1836 


57 


25 


10 


11 


43.50 


17.54 


1837 


38 


21 


12 


11 


55.26 


31.57 



Total, 255 104 55 37 40.07 21.56 

As the cures and deaths were not among those patients alone 
who entered in each several year, but among all those in the 
Asylum at the time, data of which I am not possessed, it is 
impossible to ascertain their exact per centage. On the sup- 
position, however, that as many remained in the Asylum at 
the close of the year 1837 as there were in it at the com- 
mencement of 1832, and rejecting both those numbers, we 
shall find that there was 40.07 per cent, of cures and 21.56 per 
cent, of deaths. This is the manner in which the similar sta- 
tistics of most other Asylums are calculated. The result in 
this instance cannot be very remote from the truth, and I am 
the more inclined to believe in its very approximate accuracy 
from the following table given me by M. Vander Heuvel. It 
includes the admissions and the cures during five successive 
3 r ears. 

Received. Cured. Per cent. 

Men, ... 142 ... 74 .. . 52.11 
Women, . . 75 . . . 14 . . . 1S.66 



Total, 217 8S 40.55 

This Asylum is under the care of a body of directors, called 
"Regents." They are elected, annually, by the city officers. 
Endued with the spirit of improvement, they appear to be 
determined that the institution shall be made as nearly perfect 
as means and circumstances will admit. In order the more 
completely to effect this object, they have made, among them- 
selves, a division of labour, thus being able to work with more 
efficiency than if they acted conjointly. One of their number 



28 

has charge of the finances; another, of clothing; a third, of 
the building; a fourth, of the food; and the others, of other 
departments. 

Before closing these remarks, I may observe that I was as 
agreeably surprised in this Asylum as I had previously been 
sadly disappointed in that at Amsterdam; and perhaps the 
assertion of Halliday, that "nowhere are more comfortable 
hospitals to be found than in the Netherlands/' may prove as 
correct in the present day as it was years since, at the time in 
which that author wrote. Other countries may possess larger, 
more convenient, and more elegantly furnished buildings, but 
none in which the end appears to be much more effectually 
accomplished than in that at Utrecht. 

ASYLUM AT ANTWERP. 

Being in Antwerp without letters of introduction, I went to 
the Asylum, in hopes of being allowed to see its several apart- 
ments without any special assistance of the kind alluded to. 
A man-servant in a blue frock met me at the door, and, upon 
being informed of what I wished, requested me to wait a few 
minutes, in the drawing-room, until the "Pere" should come. 
This officer soon arrived; but, what with his ignorance of both 
English and French, and mine of Dutch, not a word could 
pass between us, mutually understood. The servant, however, 
speaking French, acted as interpreter; and, through him, I 
learned that it was impossible for me to go through the esta- 
blishment without permission from one of the "Regents." 
This difficulty was overcome, as at Utrecht, by despatching 
the servant. with me to the house of one of those officers. H. 
Willsert, the gentleman to whom I thus became introduced, 
appears to be much occupied in objects of benevolence, having 
been many years a member of the "Administration des Hos- 
pices" of the city in which he resides. This "Administra- 
tion" consists in a body of men, each called "Regent," to 
whom is entrusted the general superintendence of the City 
Hospital, the Lunatic Asylum, the Foundling Hospital, and 
two Orphan Asylums, one for boys and the other for girls. 



29 

They are the trustees of a large amount of property belonging 
to the city, the interest of which is devoted to these several 
institutions. They are elected by the burgomaster, for the 
term of five years. In order to economise both time and 
labour, as well as to make the arrangements and regulations of 
all the institutions as nearly perfect as possible, by enabling 
each individual to obtain a more complete knowledge of one of 
them than he could of the whole, and to concentrate his efforts 
thereupon, the several members have divided their trust, each 
taking the principal direction of one of the establishments. 
The total number of persons under the care of the Adminis- 
tration is upwards of three thousand. H. Willaert has the 
charge of the Lunatic Asylum. 

After having spent an hour in conversation, during which I 
obtained much information in regard to the state of society in 
Antwerp, as well as in relation to the management of its seve- 
ral charitable institutions, M. Willaert offered to accompany 
me to as many of these institutions as I might feel desirous of 
seeing. Accordingly, we went to the City Hospital, the 
Foundling Hospital, and the Lunatic Asylum. Passing by 
the first two, as irrelevant to the present subject, I proceed to 
a notice of the last. 

Arrived at the Asylum, we were conducted through it by 
the "Pere," the French servant carrying the keys. The build- 
ing, composed of brick, is very old. It is but two stories in 
height, and encloses several small courts, which, like almost 
everything connected with lunatic Asylums in general, have, 
within the last few years, been made "to blossom as the rose." 
They had never been cultivated until since the commencement 
of the administration of M. Willaert. The internal construc- 
tion of the building, the arrangement of apartments, &c, is 
such as might be expected in an edifice of this kind erected a 
century since, at a time in which the comfort of the patient 
was sacrificed to a paltry economy, in which their proper treat- 
ment was unknown, and the unfortunate maniac was placed, in 
public estimation, upon a level with the criminal who has fla- 
grantly violated the laws of both God and man. The doors of 
the dormitories, throughout the establishment, still bear the 
3* 



30 

relics of those days, in the huge bolts with which, at both top 
and bottom, they are fastened. I spoke of them, in passing, 
and the gentleman accompanying me remarked that they were 
soon to be taken off. The rooms referred to are arranged on 
both sides of very narrow passages leading through each ward. 
There are 24 cells for the raving maniacs, 12 for those of each 
sex. These are small; the wainscoting is of wood, in order to 
diminish the danger of the patients injuring themselves against 
the walls; and each contains no other furniture than a bed. 
These beds are low, made of plank, and fastened to the walls. 
The mattrasses, throughout the building, are mostly of straw; 
those of the convalescent and of the pay patients are, however, 
of better materials. In the infirmary the beds are very good. 
The corpse of a patient, just deceased, was lying upon one of 
them when we passed. There are special wards for the idiots, 
epileptics and incurables. A few years since, the proportion of 
incurables was very large; but the Grippe, which prevailed so 
generally, in an epidemic form, throughout the west of Europe, 
during the winter of 1836-7, carried off many of them, and, 
subsequently, most of those who had been attacked by it and 
recovered, became victims to phthisis pulmonalis. Each class 
of patients has a court and a common hall, in which they spend 
most of their time. The halls are warmed by stoves, which 
are surrounded, at a few feet distant, by a strong reticulated 
wire fender. The dormitories, or private rooms of the 
patients, as well as the cells for the furious, are not furnished 
with the means of being warmed. At the suggestion of 
Ramon de la Sagra, the celebrated political economist of Spain, 
who visited this institution but a few days before I was there, 
the defect is about to be remedied by the introduction of a hot- 
air furnace. 

The number of patients in the summer of 183S was 130, of 
whom 60 were men and 70 women. The Asylum is suffi- 
ciently large to accommodate a much greater number. A few 
pay for their entertainment; those who are natives of Amster- 
dam, 280 florins, or 112 dollars; and others, 300 florins, or 120 
dollars, per annum. 

Regimen. — Breakfast; tea, bread and butter. The bread 



31 

is made of equal proportions of wheat and rye. Dinner; 
meat and bread four days in the week; soup and vegetables, 
with bread, the remaining three. Supper; bread and butter, 
with beer, if wanted. The beer, which is not very strong, 
but sufficiently so to be palatable, is at the command of the 
patients at all times. 

Labour and amusements have not, as yet, been extensively 
introduced. A few of the men work at small jobs, such as 
some parts of domestic labour, whitewashing, &c, and there 
is one room in which the convalescent and some of the quiet 
incurable women were spinning tow and making lace with 
bobbins. Both men and women are remunerated for what- 
ever labour they perform, it having been found "difficult, or 
nearly impossible," to induce them to work, except by the 
stimulus of pecuniary reward. Connected with the building 
is an elegant Catholic chapel, in which mass is regularly said. 
Such patients as can be admitted with propriety are allowed to 
attend. There is an apartment for the men, and another for 
the women, so arranged that they may all witness the ceremo- 
nies before the altar, without the ability to see each other or the 
rest of the congregation. Attendance upon the services is con- 
sidered a privilege, as such is dispensed, and as such is much 
sought. Thus here, as in other places, religious worship has 
been found, to a certain extent, an efficient means in the moral 
treatment of the insane. 

LA SALTPETRIERE. 

This vast Asylum for the poor, this pauper-village, if the 
term be admissible, was established by Louis XIV. in the year 
1656. It is situated on the southern shore of the Seine, in a 
remote part of Paris, and in the vicinity of the Jardin des 
Plantes. It is devoted exclusively to females, for whom it 
contains about 4500 beds. It is in the hospital of this exten- 
sive establishment, that the celebrated Cruveilhier has collected 
most of the materials for his elaborate and beautiful works upon 
pathological anatomy. The department devoted to the insane 
is, perhaps, the most extensive in the world, the number of 



32 

lunatics being from 1000 to 1200, and that of epileptics and 
idiots, from 700 to 800. The approximate number of admis- 
sions, per annum, is 500, that of discharges 300, and of deaths 
200. The cures are equal to 33^- per cent, of the whole num- 
ber admitted. "This proportion," says a French author, "is 
sufficiently large, when we consider that many of the maniacs 
do not enter the Salpetriere until after they have been treated, 
and pronounced incurable, at other hospitals (maisons-de- 
sante)" Drs. Pariset and Mitivie have charge of the depart- 
ment for lunatics. The medical visit was made by the latter 
on the morning that I was there. He seems admirably quali- 
fied, by his gentleness and kindness of manners, and his firm- 
ness of character, for the situation which he fills. It is a fact, 
too generally known to require repetition, that this establish- 
ment and the Bicetre were the chief theatres of action of the 
benevolent Pinel; that, by him, the Augean stables of their 
misery, degradation and torture were cleansed; that, at his 
suggestion, the great amelioration in the condition of the 
inmates, wrought both during his life and since, have been 
effected. France owes a debt of gratitude to this benefactor 
of a portion of her citizens, which the giving of his name to a 
ward in the Salpetriere but inadequately repays. Pope, in 
allusion to the broadly contrasted characters of the Roman 
emperors, Caesar and Titus, exclaims — 

"And which more blest, who chained his country, say, 
Or him whose virtue sighed to lose a dayl" 

In like manner, may we not ask which is "more blest," Na- 
poleon, wading through the blood of six millions of his fellow 
beings to a transient throne of despotism, or Pinel, severing 
the manacles and chains of those who had been laden with them 
merely because they were suffering under a disease to which all 
are liable, breaking up the strong holds of misery, and carrying 
light, cheerfulness and content into the abodes of darkness, 
wretchedness and woe. The ameliorations prospectively made 
by this distinguished philanthropist, and subsequently insisted 
upon by his brother in benevolence, M. Esquirol, have not, 
hitherto, been fully accomplished. A few years, however, will 
suffice for their completion. The buildings recently con- 



33 

structecl for the patients are but one story in height, surround- 
ing spacious courts.* Upon three sides there are wards, 
and, on the fourth, two bathing rooms, communicating with 
each other, and with the wards, by an extensive corridor, 
similar to the markets of Philadelphia, if deprived of their 
benches. The wards have two rows of windows, the upper 
ones, which are small and near the ceiling, being kept open at 
all proper seasons, for the purpose of ventilation. In one large 
enclosure, belonging to the establishment, there are several, 
perhaps 14 or 15, small buildings for the furious, each adapted 
to t-he accommodation of one alone. They are heated by an 
apparatus beneath the floor. In one of them there was a girl, 
of interesting appearance, who begged the physician that he 
would order a camisole to be placed upon her, lest she should 
do herself some injury. In reference to the treatment at this 
Asylum, M. Milne Edwards says: — "In the treatment of the 
insane no violent means are ever employed. The greatest 
mildness, kindness and care are constantly enjoined upon the 
attendants, and the physicians set a good example in these re- 
spects. Baths, the douche, exutories, mild purgatives, and 
medicines intended to restore suppressed evacuations are the 
principal remedial agents resorted to. Isolation and moral 
means form the basis of treatment."! 



LE BICETRE. 

The "hospice," or pauper Asylum of Bicetre, is in a 
southerly direction from Paris, about two miles from the walls 
at the barriere de Fontainebleau. It is for men alone. Its 
extent is less than that of La Salpetriere, the number of 
inmates being about 3000. The department for the insane is 

* In regard to buildings of this kind, Esquirol observes, "During the last 
twenty-five years I have often exposed the inconveniences of buildings several 
stories in height. I have so loudly proclaimed the advantages of a ground 
floor as the dwelling place for the insane, that I shall abstain from remarking 
upon them here, particularly as in France, as well as in foreign countries, my 
principles have been received and put in practice in the construction of lunatic 
Asylums. 

t Notice sur les Hdpitaux de Paris, in the Nouveau Formulairc Pratique des 
Hopitaux, by Milne Edwards and P. Vavasseur. 



34 

proportionally smaller. The number of patients in May, 
1S3S, was 760. Besides these there were about 200 idiots. 
The average number of admissions, annually, is, for the insane, 
360; the imbecile, 40; that of discharges of the former, per 
month, 12 to 15; the deaths about the same, and the cures from 
7 to S. The proportion of deaths to the whole number ad- 
mitted is as 1 to 6, or 16.66 per cent. The medical care 
of the patients is confided to Drs. Ferrus and Pinel. The work 
quoted at the close of the remarks upon La Salpetriere says, 
in reference to this Asylum: — "Every thing disapproved of 
by Pinel has been destroyed; all that he required has been 
executed. The lodges have disappeared, large promenades have 
been made, and the number of attendants is increased. There 
is a farm upon which sixty of the patients labour daily. It is 
impossible to describe all the good resulting from these mea- 
sures. Formerly, if the department of the insane bore the 
least resemblance to any other place, it was to a hell; — now, all 
is calm, and it is not rare for whole nights to pass without 
hearing the slightest noise." 

The whole number of insane who labour is about two hun- 
dred. The establishment is supplied with water from large 
and deep wells, whence it is pumped into reservoirs by the 
patients. 

Admission to the department for the insane can be obtained 
only by a special permission from the "Directeur" of the 
establishment. An English physician accompanied me to the 
place, and having obtained a permit, we entered. Dr. Pinel 
made the medical visit for the day, and we accompanied him 
through all the wards. He, too, like his illustrious predecessor 
of the same name, appears to take a lively interest in the un- 
fortunate class of persons with whose treatment he is entrusted, 
and seems well qualified, by both nature and education, for the 
important and responsible station which he occupies. Many 
of the patients greeted him with a "bon jour;" those who 
were not confined to their beds thronged around him, to con- 
verse, some seizing his hand and saying, "Vous etes un bien 
brave homme," or some other compliment of a similar kind, 
he, the while, treating them as his friends and companions, and 



35 

adapting his conversation to each, according to his particular 
hallucination. In one of the wards which we first entered, a 
merry patient, seeing us approach, took his violin for the pur- 
pose of giving his physician a musical entertainment. He 
followed us through the ward, playing several lively airs, and 
when we were about to leave, insisted upon accompanying us. 
The doctor permitted him so to do, and he followed us, Con- 
stantly playing upon his fiddle, through most of the remaining 
wards. 

The recently constructed buildings of the Bicetre are upon 
the same plan as those of La Salpetriere, though not so spacious. 
The courts are planted with trees, and supplied with permanent 
seats beneath the shade. After the visit was completed, we 
went to the bathing-room, which is furnished with perhaps a 
dozen tubs. Over each of several of them, at the height of 
about five feet from its top, is a douche, the diameter of the 
stream of which is a little more than three-fourths or about 
seven-eighths of an inch. There were patients in two of the 
tubs, each being confined in his place by a board passing around 
the neck, as in a pillory. One of them was a robust man, of a 
nervo-sanguineous temperament, who, during the course of his 
alienation, had been subject to several hallucinations. At one 
time he talked so long and so constantly as to produce aphony. 
At another time he was rich as Croesus, and 25,000 francs of 
his annual income accrued from a pinch of snuff. He now 
believed himself to be the husband of the Duchess de Berri, 
and a favourite friend of the ex-king, Charles X., and of his 
son, the Duke de Bordeaux; that these persons had recom- 
mended him to Louis Philippe, who showed him particular 
attention and was about to load him with honours. On the 
previous day, he had requested to be furnished with materials 
for writing. These were given to him on condition that he 
should write something reasonable, and not the wild vagaries 
with which his mind was haunted. He wrote a letter to M. 
Dupin, president of the Chamber of Deputies desiring that gen- 
tleman to give his compliments to Louis Philippe, with many 
thanks for the kindness which he had received, and should re- 
ceive, in future, from his royal highness. Pinel approached 



36 

the patient with this document in his hand, reminded him of 
the conditions upon which he was permitted to write, read to 
him the letter, an amusing tissue of absurdities, and then asked 
him if he still believed himself to be a favourite of the royal 
family. "Oui, Monsieur," was the instantaneous reply. "Give 
him the douche," said Pinel. A servant who stood waiting 
orders, turned the waler-cock and the stream fell directly upon 
the vertex of the patient's head. He struggled, writhed and 
screamed under the shock, and begged that it should be stopped. 
This request was complied with in a few seconds. Pinel. 
"Do you still entertain the foolish idea that you are an intimate 
friend of Charles X." Patient. % think I do." Pinel. "Let 
him have the douche." This was no sooner ordered than 
obeyed. The patient floundered, hallooed, and begged as be- 
fore. The douche was stopped. Pinel. "Are you an intimate 
friend of Charles X. and the Duke de Bordeaux?" Patient. 
"I presume so." Pinel. "Give him the douche." It was 
given with all the previous results. The doctor again read 
some portions of the letter, attempted to convince the man of 
the absurdity of his notions, and concluded by asking him 
w r hat marks of attention he had ever received from the "Roi 
dechu." Patient. "You are aware, Monsieur Pinel, of the 
important works of which I am author, and which were 
written long since. I presume, sir, that Charles X. takes a 
great interest in those, and consequently in me; besides, he 
has given me a letter of recommendation to Louis Philippe, 
from whom I have received so many proofs of friendship." 
Pinel. "It is impossible that Charles X. should have given 
you a letter of that description to Louis Philippe, since they 
and their families are at enmity with each other." The patient 
muttered something about Henry V. and an umbrella. Pinel. 
"France knows no such person as Henry V.; when you speak 
of the gentleman referred to, call him Duke de Bordeaux." In 
this manner nearly half an hour was occupied, the douche 
being administered whenever the patient insisted upon the truth 
of his fantastical ideas. At length, what with the arguments 
of the doctor, and what with the still more cool and cogent 
logic of cold water to the head, the patient yielded his points, 



37 

deeply regretting, however, to be thus shorn of his splendour, 
and so unceremoniously brought down from his "high estate." 
Pinel then gave him a lesson to commit to memory for the 
following day. 

The other patient was meagre and of a bilious temperament. 
Throughout the scene which we have partially described, he 
remained perfectly quiet in his bath. On the day previous a 
task of manual labour had been given him, and he had left it 
untouched. Pinel approached and asked him why he had 
done so. He looked up with a smile, and a most ludicrous 
leer of the eye, as he said, "To speak candidly, sir, I felt no 
particular desire to work. " The doctor himself could hardly 
refrain from laughter. "Well," said he, "will you work 
hereafter, when you are ordered to?" The patient reflected a 
moment, then looked up with the same expression of counte- 
nance as before, and said, "I will not work, my word of 
honour for it." "Give him the douche," said the doctor, and 
the stream of water instantly fell upon the patient's head. 
The effect was even greater upon him than it had been upon 
the other, insomuch that, in a moment, like a child smarting 
under castigation, he exclaimed, "I will, I will." The douche 
was stopped, and the task left unfinished on the previous day 
was ordered to be completed before night. 

That the douche employed as in the two cases above men- 
tioned is not only destitute of utility, but absolutely and de- 
cidedly injurious, does not, in my opinion, admit a doubt. 
The real frenzy to which the former patient was driven by the 
combined effects of a positive and determined contradiction of 
his hallucination, and the agitation produced by his knowledge 
of the fact that the douche was used as a means of compulsion, 
caused a rush of blood to the brain, the deleterious influence of 
which could not be overcome by the sedative effects of the 
cold water. ' Nor can we believe that the immediate object in 
view in the case in question, that of dispelling the illusion 
under which the unfortunate maniac was labouring, was either 
gained or even approximated, for the dread of the douche 
compelled the man to sacrifice truth on the altar of fear, and 
4 



made his tongue belie his still persistent belief. It is with the 
insane as with the sane, 

"Who is convinced against his will, 
Is of the same opinion still." 

During the past year (1840) we have made a very free use 
of the cold douche in the Frankford Asylum, but in no instance 
has it been employed as a means of coercion or of punishment. 
It is of decided advantage in all cases in which there exists a 
determination of blood to the brain, indicated by flushings of 
the face, and excessive heat, either constant or variable, of the 
integuments of the cranium. A majority of the patients who 
have been submitted to its influence, have preferred to use it, 
on account of the refreshment and relief thereby produced. 
Several of them have been accustomed to applying it to their 
heads, from day to day, voluntarily. The douche in this in- 
stitution is the only one I have seen in this country, and I am 
not aware that it has been resorted to as a curative means in 
any other Asylum for the Insane in the United States. It is 
so constructed as to make the stream of water of variable size, 
from one-fourth to three-fourths of an inch in diameter. The 
water falls from two to four feet, according to the situation of 
the head of the patient. 

The Bicetre is hallowed as being the scene of the boldest 
and noblest achievement recorded in the annals of insanity. 
Here, morning first dispelled the midnight gloom of lunacy, 
and the guiltless maniac was released from the thraldom which 
associated him with criminals and brutes, taken by the hand, 
as a brother, and acknowledged to be worthy of the kindest 
attention, commiseration and sympathy. 

The following brief account of the commencement of the 
labours of Pinel, extracted from a paper read by his son, before 
the Ro3^al Academy of Sciences, commends itself to the atten- 
tion of every reader: 

"Towards the end of 1792, Pinel, after having many times 
urged the government to allow him to unchain the maniacs of 
the Bicetre, but in vain, went himself to the authorities, and 
with much earnestness and warmth, advocated the removal of 
this monstrous abuse. Couthon, a member of the commune, 



39 

gave way to M. Pinel's arguments, and agreed to meet him 
at the Bicetre. Coulhon then interrogated those who were 
chained, but the abuse he received, and the confused sounds of 
cries, vociferations and clanking of chains, in the filthy and 
damp cells, made him recoil from Pinel's proposition. 'You 
may do what you will with them,' said he, 'but I fear you 
will become their victim.' Pinel instantly commenced his 
undertaking. There were about fifty whom he considered 
might, without danger to the others, be unchained, and he 
began by releasing twelve, with the sole precaution of having 
previously prepared the same number of strong waistcoats, 
with long sleeves, which could be tied behind the back if ne- 
cessary. The first man on whom the experiment was to be 
tried was an English captain, whose history no one knew, as 
he had been in chains for forty years. He was thought to be 
one of the most furious among them. His keepers approached 
him with caution, as he had in a fit of fury, killed one of them 
on the spot with a blow from his manacles. He was chained 
more rigorously than any of the others. Pinel entered his 
cell unattended, and calmly said to him, 'Captain, I will order 
your chains to be taken off, and give you liberty to walk in 
the court if you will promise me to behave well, and injure 
no one.' 'Yes, I promise you,' said the maniac, 'but you are 
laughing at me — you are all too much afraid of me.' 'I have 
six men,' said Pinel, 'ready to enforce my commands, if neces- 
sary. Believe me then, on my word, I will give you your 
liberty if you will put on this waistcoat.' 

"He submitted to this willingly, without a word. His 
chains were removed, and the keepers retired, leaving the 
door open. He raised himself many times from his seat, but 
fell again on it, for he had been in a sitting posture so long, 
that he had lost the use of his legs. In a quarter of an hour 
he succeeded in maintaining his balance, and with tottering 
steps came to the door of his dark cell. His first look was at 
the sky, and he cried out enthusiastically, 'How beautiful!' 
During the rest of the day he was constantly in motion, walk- 
ing up and down the staircases, and uttering short exclama- 
tions of delight. In the evening he returned of his own 
accord into his cell, where a better bed than he had been 



40 

accustomed to had been prepared for him, and he slept tranquil- 
ly. During the two succeeding years which he spent in the 
Bicetre, he had no return of his previous paroxysms, but even 
rendered himself useful by exercising a kind of authority over 
the insane patients, whom he ruled in his own fashion. 

"The next unfortunate being whom Pinel visited was a sol- 
dier of the French guards, whose only fault was drunkenness; 
when once he lost his self-command by drink, he became 
quarrelsome and violent, and the more dangerous from his 
great bodily strength. 

"From his frequent excesses, he had been discharged from 
his corps, and he had speedily dissipated his scanty means. 
Disgrace and misery so depressed him that he became insane; 
in his paroxysms he believed himself a General, and fought 
those who would not acknowledge his rank. After a furious 
struggle of this sort, he was brought to the Bicetre in a state 
of great excitement. He had now been chained for ten years, 
and with greater care than the others, from his frequently 
having broken his chains with his hands only. Once when 
he broke loose, he defied all his keepers to enter his cell, until 
they had each passed under his legs; and he compelled eight 
men to obey this strange command. Pinel, on his previous 
visits to him, regarded him as a man of original good nature, 
but under excitement incessantly kept up by cruel treatment; 
and he had promised speedily to ameliorate his condition, 
which promise alone had made him more calm. Now he an- 
nounced to him that he should be chained no longer, and, to 
prove that he had confidence in him, and believed him to be 
a man capable of better things, he called upon him to assist in 
releasing those others who had not reason like himself, and 
promised, if he conducted himself well, to take him into his 
own service. The change was sudden and complete. No 
sooner was he liberated than he became attentive, following 
with his eye every motion of Pinel, and executing his orders 
with as much address as promptness. He spoke kindly and 
reasonably to the other patients; and during the rest of his 
life was entirely devoted to his deliverer. And <I can never 
hear without emotion/ says Pinel's son, 'the name of this 
man, who some years after this occurrence shared with me 



41 

the games of my childhood, and to whom I shall always feel 
attached.' 

"In the next cell were three Prussian soldiers, who had 
been in chains for many years, but on what account no one 
knew. They were, in general, calm and inoffensive, becom- 
ing animated only when conversing together in their own 
language, which was unintelligible to others. They were 
allowed the only consolation of which they appeared sensible 
— to live together. The preparations taken to release them 
alarmed them, as they imagined the keepers were come to 
inflict new severities; and they opposed them violently when 
removing their irons. When released, they were not willing 
to leave their prison, and remained in their habitual posture. 
Either grief or loss of intellect had rendered them indifferent 
to liberty. 

"Near them was an old priest, who was possessed with the 
idea that he was Christ; his appearance indicated the vanity 
of his belief; he was grave and solemn; his smile soft, and at 
the same time severe, repelling all familiarity; his hair was 
long, and hung on each side of his face, which was pale, intel- 
ligent, and resigned. On his being once taunted with a ques- 
tion, that 'if he was Christ he could break his chains,' he 
solemnly replied, 'Frustra tentaris Dommum tuum.' His 
whole life was a romance of religious excitement. He under- 
took, on foot, pilgrimages to Cologne and Rome, and made a 
voyage to America for the purpose of converting the Indians; 
his dominant idea became changed into an actual mania, and 
on his return to France he announced himself as the Saviour. 
He was taken by the Police before the Archbishop of Paris, 
by whose orders he was confined in the Bicetre as either im- 
pious or insane. His hands and feet were loaded with heavy 
chains, and during twelve years he bore with exemplary 
patience, martyrdom and constant sarcasms. 

"Pinel did not attempt to reason with him, but ordered 
him to be unchained in silence, directing, at the same time, 
that every one should imitate the old man's reserve, and never 
speak to him. This order was rigorously observed, and 
produced on the patient a more decided effect than either 
4* 



42 

chains or the dungeon; he became humiliated by this unusual 
isolation, and introduced himself to the society of the other 
patients. From this time his notions became more just and 
sensible, and in less than a year he acknowledged the ab- 
surdity of his previous prepossessions, and was dismissed from 
the Bicetre. 

"In the course of a few days, Pinel released fifty-three 
maniacs from their chains; among them were men of all condi- 
tions and countries; workmen, merchants, soldiers, lawyers, 
&c. The result was beyond his hopes. Tranquillity and har- 
mony succeeded to tumult and disorder; and the whole disci- 
pline was marked with a regularity and kindness, which had 
the most favourable effect on the insane themselves; rendering 
even the most furious more tractable." 

ASYLUM AT CHARENTON. 

Dr. Louis favoured me with a letter of introduction to M. 
Esquirol, the medecin en chef of the Asylum at Charenton, 
and the distinguished veteran in the treatment of the insane. 
With this I went to the Asylum, where I had the pleasure of 
meeting him to whom it was addressed, in the scene of his 
present labours, among the unfortunate people who love and 
honour him as a father, and in whose welfare his interest con- 
tinues unrepressed by the weight of accumulated years. After 
his visit to the patients was completed, I sat an hour with him 
in the parlour of the institution, during which time he con- 
versed chiefly upon the subjects of lunacy and of Lunatic Asy- 
lums. After speaking of the comparative merits of the various 
establishments of the kind in Europe, and giving the preference 
to that at Reggio, in Italy, over all others that he had ever 
visited, he made many inquiries with regard to those of the 
United States, and expressed much interest in the progress of 
improvement in the treatment of the insane, upon this side of 
the Atlantic. 

The Asylum of Charenton, in a village of the same name, 
is about five miles eastwardly from the city of Paris. It is 
situated upon the southern declivity of a hill, which runs 



parallel to the river Marne, near its shores, and but a short 
distance from its junction with the Seine. It was originally a 
hospital, under the care of the Brothers of Charity. About 
the beginning of the 18th century, a department was, for the 
first time, devoted to the reception of those labouring under 
mental alienation. In 1795 the hospital was suppressed, but in 
1797 it was re-established and devoted exclusively to the 
treatment of the insane. It is now called, in common with 
some other establishments of the kind in other parts of France, 
"Maison Royale d'Alienes. " It includes many edifices, which 
have been erected at various periods, and extensive gardens 
and promenades, which extend to the summit of the hill upon 
the declivity of which it is located. The following description 
is translated from the recent elaborate work of M. Esquirol, to 
which we are also indebted for most of the subject matter for 
our remarks upon this Asylum.* "The section for men is 
composed of four courts, of which three are planted; three 
infirmaries; one ward for patients of a suicidal propensity; 
one dormitory; one gallery and six corridors, into which 
open the doors of the several rooms; one bathing room, and 
six rooms where the patients assemble. These last mentioned 
can be heated. The section for women has a garden, four 
planted courts, two infirmaries, one ward for women disposed 
to commit suicide, two bathing rooms, seven dormitories, six 
galleries and corridors into which open the doors of the apart- 
ments, and five rooms in common, which may be heated." 

An extensive additional department for females, combining 
most of the modern improvements, was erected about twelve 
years since, and first occupied in 1829. This is one of the 
best arranged and most neatly-kept establishments of the kind 
that I have had occasion to examine. The furniture is good 
and sufficiently handsome, without being extravagant. The 
beds of the dormitories are hung with white curtains. No 
corresponding department for the men has hitherto been 
erected. There is a parlour in the Asylum, in which those 

* Des maladies mentales, considerees sous les rapports medical, hygienique 
et medico-legal, par E. Esquirol. Paris, 1838. 



patients the state of whose disease renders them admissible, 
assemble every evening for social intercourse. This contains 
many arm-chairs, several card-tables and a piano-forte. A 
room having tables for billiards, is devoted to that amusement. 
The bathing room of the new department for females contains 
ten copper tubs, separated from each other by curtains, and 
each supplied with a cover which may be used in case of ne- 
cessity. A chapel, or oratory, is devoted to religious worship; 
the exercises being conducted in the Catholic form. The 
priest (aumonier) resides at the Asylum. Ministers of other 
sects are, at the request of patients, permitted to visit them in 
their wards. 

There are three grades of prices for entertainment at this 
institution: the 1st, 1300; the 2d, 1000; and the 3d, 720 francs 
per annum. The regimen of the patients varies according to 
the grade, and is of a quality proportionate to the prices of 
those grades. The rules of the establishment require that there 
shall be one attendant to every tenth patient, but this number, 
according to M. Esquirol, is not sufficient. There are 73 in 
all, two of whom remain in the garden to oversee those who 
are walking. Several others have charge of but one or two 
patients each. The number of persons employed at the Asy- 
lum, including, on the one hand, the visiting physician, and, 
on the other, the gardeners, gate-keeper and hostlers, is 170. 

The number of admissions, from the establishment of the 
institution exclusively for lunatics, in 1797, to the end of the 
year 1833, is 5972. The following list exhibits the same num- 
ber divided in the proportion that the patients were received 
in several different epochs. 



From 1797 to 1802 


. 


. 202 


1802 " 1805 


. 


. 435 


1805 " 1810 


\ 


. 1007 


1S10 " 1815 


. 


. 722 


1815 " 1825 


. . 


. 2049 


1S25 " 1834 


• • 


. 1557 



Total, . . . 5972 



45 



Previously to 1815, the number of each sex was not desig- 
nated, but from that year to 1825 there were 1245 men and 
S04 women; and from 1825 to 1834, 932 men and 625 
women. 

The following table, compiled, with some additions, from 
several of those in the work above quoted, exhibits the number 
of admissions for each of the years between 1825 and 1834, 
the condition in society (etat civil) of the patients, and the re- 
sults of their treatment. 











■r 








o- 


"o 














j o 


15 








"3 


z 








~ , 


«3 


. 




13 


£ 








g 




m 

o 

>< 


a 

o 

3 


o 

5b 

c 


ffl 


is 


o 

- 
3 


5i 


-6 
a 

3 




CD C/i 


s 

o 
> 


05 




o 
— 


'a 

0) 

3 


11 


-d 

2 




O 00 

II 


1826 121 


6S 


49 


4 


34 


39 


59 


28.09 


48.76 


89 


34 


49 


6 


41 


35 


28 46.05 


31.57 


1827 123 


72 


41 


10 


51 


34 


42 


41.46 


34.14 


82i 26 


48 


8 


24 


29 


17129.26 


20.73 


1828 122 


66 


51 


5 


34 


34 


54 


27.86 


44.26 82 27 


44 


11 


25 


23 


21 130.48 


25.60 


1829 121 


59 


55 


7 


40 


38 


58 


33.05 


47.10 l 71 19 


47 


5 


28 


27 


1539.43 


21.12 


1830 112 


54 


52 


6 


34 


52 


44 


30.35 


39.28 


i 74 18 


49 


7 


29 


19 


21 39.18 


28.37 


1831 109 


64 


42 


3 


22 


31 


51 


20.18 


46.60 


| 82 27 


44 


11 


29 


44 


14 35.36 


17.07 


1832118 


60 


56 


2 


36 


40 


38 


30.50 


32.20 


79 24 


43 


12 


29 


24 


17 49.35 


21.51 


1833 106 

1 


62 

505 


41 

3S7 


3 
40 


33 
284 


33 
301 


60 

406 


3113 


56.60:', 66 18 


39 

363 


9 
B9 


29 
231 


25 

226 


7 43.93 


10.60 




932 




" 


!625 


193 


140 





The proportion of single men, as calculated from this table, 
equals 54.18 per cent.; of single women, 30.SS per cent; of 
married men, 41.52 per cent.; of married women, 5S.08 per 
cent., of widowers, 4.29 per cent.; and of widows, 11.04 per 
cent. It is a singular fact that the proportion of married men 
is but about two-thirds as great as that of married women, 
while that of single men is nearly twice as great as that of 
single women. 

The total number of cures is 518, equal to 64.7+ per an- 
num; that of deaths 546, or 6S.3 + per annum. It will be 
perceived, by the table, that the greatest proportion of the an- 
nual cures of men was in 1827, = 41.46 per cent, and that of 
women, in 1832, = 49.35 per cent; also, that the least pro- 
portion of the cures of men was in 1831, = 20. IS per cent, and 
that of women, in 1827, = 29.26 per cent. The proportion 
of the deaths of men was largest in 1833, == 56.60 per cent; 
that of women, in 1826, = 31.57 per cent; the proportion was 



46 

least, for men, in 1S32, — 32.20 per cent.; and, for women, 
in 1833, = 10.60 per cent. 

The average number of cures, per annum, was, for men, 
30.32 per cent.; for women, 39.13 per cent.; and for both 
sexes, inclusive, 34.72 per cent. The average of deaths was, 
for men, 43.61 per cent.; for women, 22.07 per cent; and for 
both, 32.84 per cent. 

In regard to the ratio of cures, M. Esquirol says that there 
were 355 epileptics, paralytics and idiots among those admitted, 
all of whom were considered, at the time of their entrance, as 
incurable. Deducting this number from 1557, the total of 
admissions, there will remain but 1205 as under curative treat- 
ment. The proportion of cures, in this case, will be as 1 to 
2.33 or equal to 42.14 per cent. The mortality, as exhibited 
by the table, is very great; but, in making out the per centage, 
the 492 patients who were in the Asylum at the commence- 
ment of the year 1826, and among whom, according to Esqui- 
rol, death made its greatest ravages, were not taken into con- 
sideration. If these be added to the number admitted, we 
have a total of 2049, to which the deaths, 546, are in the pro- 
portion of 1 to 3.75 + , or 26.64 per cent. It is proper to remark 
that the insane of all descriptions are admitted, irrespective of 
age, grade of disease or its duration, or of the many other ma- 
ladies with which it may be complicated. Again, very few 
persons attacked by "those acute diseases of the encephalon, 
which, as people say, are ahvays cured, and w r hich increase 
the number of cures of some similar establishments," are 
brought to this institution. From these facts we cannot expect 
the ratio of cures to be very large. The mortality of men 
considerably exceeded that of women. That of the latter was 
much less in the last than in the first years of the period; and, 
at the same time, there was a corresponding increase of cures. 
These facts are very plausibly accounted for, in that the women 
occupied the new and commodious building, before mentioned, 
during the last five years. 

We now present a table exhibiting the admissions and the 
results of treatment, in reference to the different seasons of the 
year. 



47 



Season. Admitted. 


Cured. 


Died. P 


er ct. of cures. I 


'er ct. of deat 


Winter, 341 


92 


160 


26.97 


46.92 


Spring, 406 


123 


139 


30.29 


34.23 


Summer, 445 


145 


119 


32.S0 


26.74 


Autumn, 365 


158 


128 


43.28 


35.06 



Total, 1557 518 546 

The average of admissions was 194 per annum. The maxi- 
mum number in any series of the same month was in that of 
July, and of seasons, as will be seen above, in summer. The 
minimum of men, and of both sexes inclusive, was in winter; 
but that of women was in spring. The proportion of cures 
was greatest in autumn, and least in winter; that of deaths, 
greatest in winter and least in summer. 

The next table shows the ages of the patients at the time of 
admission. 





o 




































o 

CO 


in 

CO 


Q 


v-O 


© 

uO 


i-O 

in 


§ 




© 




— 

X 


X 


- 




0J 


o 


o 


O 


o 


O 


o 


O 


o 


o 


o 


o 


o 


O 


o 






o 


in 


o 

CO 


ib 

CO 


o 




© 

in 




© 


«3 


i 


in 


9: 


in 

X 


Men, 


82 


119 


135 


130 


106 


105 


83 


68 


37 


35 


25 


4 


2 


i 




Women, 


42 


55 


72 


77 


102 


90 


65 


46 


36 


22 


10 


2 


4 


l 


1 



Total, 124 174 207 207 208 195 148 114 73 57 35 6 6 2 1 

Hence it appears that the greatest number of men during any 
period of five years was 135, and that between the ages of 25 
and 30; the maximum of women was 102, between the ages 
of 35 and 40; and that of both sexes inclusive 20S, between 
the ages of 35 and 40. The number second in rank is found, 
for men, between the ages of 30 and 35, and for women, be- 
tween 40 and 45. The number under 20 years occupies, for 
the men, the third rank, for the women, the sixth rank. From 
these results, Esquirol is led to infer that insanity generally 
occurs at an earlier period of life in men than in women. It 
will be seen that more men than women enter this Asylum: 
the former are to the latter nearly as 3 to 2. This difference 
arises from the number of soldiers and marines who resort 
here to be cured. Esquirol has ascertained by his researches, 
that of 76,000 lunatics, in various countries, the proportion of 
men to women is as 37 to 38. The ratio differs in different 



48 

nations, according to climate, habits and other modifying in- 
fluences. 

The number of patients in each variety of insanity, together 
with the results of treatment upon them, respectively, will be 
seen in the following table. 

Men. Cures. Percent. Women. Cures. Percent. Remark. 

Monomania, 372 123 33.06 343 128 37.31 * 

Mania, 334 160 47.93 211 103 48.81 c ^ 

Dementia, 219 1 .45 62 3 4.83 §fg 
Idiocy, 8 7 



Total, 933 284 623* 234 



2.» 



The cures in monomania of both sexes, inclusive, were equal 
to 35.10 per cent.; those in mania, 48.25 per cent., and those 
in dementia, 1.42 per cent. The number of patients affected 
with monomania exceeded that of any other variety; but the 
per centage of cures has its maximum in mania. 

Of the 1557 cases, the causes are assigned to 1375; they are 
as follows. "Hereditary, 337; domestic chagrins, 278; liber- 
tinage, excesses of all kinds, 146; abuse of spirituous liquors, 
134; suppression of habitual evacuations, 54; onanism, 52; 
reverse of fortune, 49; abuse of mercury, 44; disappointed 
love, 37; fright, 35; political causes, 32; parturition, 28; ex- 
alted devotion, 24; blows on the head, 20; jealousy, 18; cere- 
bral affections, 17; excess of study and night waking, 16; 
wounded self-love, 16; reading of romances, 13; insolation, 
12; love of play, 5; suppression of habitual suppuration, 3; 
cholera morbus, 3; excess of joy, 2." Total, 1375. 

Esquirol thinks that the proportion of cases arising from 
hereditary predisposition is usually greater than in this in- 
stance. In relation to those arising from political causes, we 
may remark that none occurred previously to 1S30. In that 
year, the year of the last revolution, there were 13 cases of 
this nature, and 15 in 1831. 

The following is a list of the several trades and professions 
previously pursued by the patients, with the exception of a few, 
in which there was but one each. ''Proprietors (landlords) 307, 
tillers of the ground 99, masons 7, locksmiths 5, cabinet-makers 
16, bakers 1 9, butchers 10, sellers of hog's flesh (charcutiers) 4, 



49 

grocers 31, wine-merchants 26, tunnelers 3, tavern-keepers and 
cooks 24, jewellers 13, tailors and shoemakers 17, cap makers 
and hosiers 5, hatters 5, modistes and cutters 35, merchants and 
clerks 81, tobacco dealers 7, military officers 103, soldiers 124, 
conductors of public coaches and couriers 11, teachers 30, 
students 46, priests 1 1, "seminarists" 4, nuns 5, physicians 15, 
apothecaries 9, advocates 9, notaries 6, clerks (commis de 
bureau) 83, "clercs d'avoue" 10, ushers or door-keepers 6, 
literary men 3, painters 8, musicians 4, printers and booksel- 
lers 15, domestics 35." 

In the years 1826, 1830, and 1831, a much larger number 
of proprietors entered the Asylum than at any other time. 
This is explained by the difficulties, in the first of those years, 
arising from the order for the reimbursement of rents; and, in 
the last two, by the pecuniary losses necessarily augmented by 
the revolution. 

ASYLUM AT MILAN. 

Saint John's Hospital, at Milan, is one of the most exten- 
sive institutions of the kind in the world. It is probably 
exceeded by none. The principal edifice appertaining to it 
is within the city, but the department for the insane is 
without the walls, about a mile distant from the Porta Tosa. 
This building, formerly a convent of the Jesuits, was enlarged 
and converted into a Lunatic Asylum, about 55 years since. 
It encloses large courts, but those which are devoted to the 
use of the patients are chiefly external to it. The wards are 
very large, some of them consisting of a hall, of ample width, 
running the whole length, and, beside it, two or three dormi- 
tories, each containing numerous beds. In others, there are 
dormitories upon both sides of a narrow passage. The rooms 
are all lofty and well ventilated. In those where a fire is re- 
quired, the stove is placed in the middle of the room and 
covered on all sides with bricks, and surrounded by strong 
wooden frames or fenders. The beds for the furious have con- 
fining rings and straps at the foot and the sides, like those in 
many other Asylums. The mattrasses are made, some of straw, 
5 



50 

some of wool, and some of hair; and the beds and linen are 
as neat, though not so elegant, as those in any institution I 
have ever visited. In some of the dormitories metallic pots- 
de-chambre are fastened by straps to the bedsteads. In the third 
story of the department for women, there is a ward consisting 
of a suite of small rooms, each opening from a narrow gallery. 
The bed in each of these is beneath the window, at the extre- 
mity opposite the door. Beside it, in the corner, is a stool of 
convenience, communicating with a balcony on the outside 
of the building, where a servant can attend to it without enter- 
ing the room. The infirmary contains many beds, four of 
which alone were occupied. The patient in one of these was 
labouring under pelagra, a disease which is endemic in some 
parts of the north of Italy. Many of the patients who were 
not confined in the infirmary have the goitre, the swellings 
being of various dimensions. I had previously seen many 
cases of this disease in Savoy and the canton of Vallais, in 
Switzerland. In one case which I saw at Sion, a town among 
the Alps and upon the road over the Simplon, the left lobe of 
the thyriod gland equalled in dimensions the head of the 
woman who was afflicted with it. One ward in the depart- 
ment of each sex, in the Asylum under notice, is devoted to 
convalescent patients. In these they remain forty days, pre- 
viously to leaving the Asylum, for the purpose of confirming 
a cure. The bathing room contains four baths, three of them 
for one person each, the other sufficiently large to accommodate 
2S at the same time. Each of the three former is cut from a 
single stone. They are for the most violent patients, and con- 
sequently have fixtures for the purpose of fastening the feet and 
the body. The large bath is also constructed of stone. The 
streams of the douches are very small, but they fall from a 
height of 12 or 15 feet. A horizontal jet, in which the water 
is thrown, with considerable force, completely across the room, 
is intended for a similar purpose as the douche. Being thus 
arranged" it may be more easily applied to the various parts of 
the body. 

Three physicians, two resident and one "attending," do 
the medical service of the Asylum. The number of patients, 



51 

in November, 1S3S, was 420, of whom 215 were men and 
205 women. The accommodations are sufficient for 500. 
The number of wards for either sex is six, and the patients are 
divided into three classes, the furious, the tranquil, and the 
incurable. 

Regimen. — Breakfast; bread and cheese. Dinner; meat, 
five days in the week, and polenta — a pudding made of the 
meal of Indian corn — the remaining two days. Wine is a 
constant drink at this meal. Supper; bread, cheese, and 
wine. 

Manual labour is pursued to a considerable extent by the 
patients. A large garden belonging to the Asylum furnishes 
employment to nearly 100 of them during the warm season. 
In one room through which we passed, between 40 and 50 
men were engaged in braiding paglia di Spagna — Spanish 
straw — for carpets. They worked as steadily, and appeared 
as orderly, as if they had not been lunatics. In another apart- 
ment several men were employed in making shoes, and as 
many more in tailoring. One of the latter was cutting clothes. 
Soon after we entered, he commenced talking to me, and con- 
versed so rationally that I supposed him to be a sane person, 
acting as overseer to the others. Under this supposition, I 
inquired of him if all those under his care were insane, to 
which he answered in the affirmative. Perceiving that he 
conversed in French, I asked him if he was a Frenchman. 
He replied that he was not, and added, a Je suppose que vous 
etes Anglais." "No," said I, "I am an American." "Ah! 
vraiment," he responded, dropping his shears and lifting both 
hands, as if agreeably surprised, "vous etes Americain. Eh 
bien, vous etes tres heureux, vous etes carbonaro. Tous les 
Americains sont des carbonari; Je voudrais bien etre dans ce 
pays la." Knowing the subject of the carbonari to be rather 
a delicate one in Italy, these remarks, together with some 
others, subsequently made, induced me to suspect him insane, 
and this suspicion, upon inquiry of the "direttore" of the 
Asylum, who accompanied me, proved correct. An artist, in 
the same apartment with the above mentioned, was occupied 
in cutting designs in paper. He showed me a representation 



52 

of Bonaparte at St. Helena, and another of the garden of 
Eden. They were, indisputably, the most elegant workman- 
ship of the kind that I have ever examined. I attempted to 
purchase the latter, but he informed me that it was already 
disposed of. 

Many of the women were making lint, or charpie, for the 
use of the hospital in the city; and, in one apartment, there 
were about 90 sewing and spinning tow upon throstles whirl- 
ed in the hand. For coercion and punishment, the douche, 
confinement in bed, the restraint of limbs, &c. are effectual 
means. I observed one patient manacled with irons, and 
strong leather mittens upon his hands. He tears off his 
clothes whenever his arms are unrestrained. Several others 
had on strong leathern belts, to which their arms were fasten- 
ed. In the same ward with these men there was another, 
very gentleman-like in appearance, who was exceedingly anx- 
ious lest I should go away without being aware of his dignity, 
or of the distinguished honour I had received in being admit- 
ted into his presence. Accordingly, he approached me, and 
repeated, with the utmost volubility, a long list of titles which 
he graced, such as "Prince" of one place; "King" of another; 
"Emperor" of a third; and, finally, "Ruler of the World." 
In his anxiety to furnish me with this important information, 
he followed us far out of the ward. 

The only means of amusement which I saw were a swing 
and a giustra, if I rightly understood the word. The latter 
is so constructed that four, or, indeed, eight persons may turn 
horizontally in a circle, being situated at the extremities of 
two beams which cross each other at right angles, in the cen- 
tre. These are in the principal court occupied by the men. 
The court is shaded by two parallel rows of sycamore trees, 
beneath which are many seats for the patients, permanently 
fastened to the ground. 

ASYLUM AT VENICE. 

Pertaining to the civil hospital at Venice, there is a large 
edifice exclusively devoted to the insane. It is situated upon 



53 

the eastern limits of the city, beside the celebrated church of 
San Giorgio e Paolo, and in the corner, at the confluence of 
one of the lagunes with the Adriatic. It is three stories in 
height, and entirely surrounds a court about 100 feet square. 
A corridor passes around this court, furnishing shelter from 
both sun and rain. In November, 1838, this Asylum con- 
tained 230 patients, all of whom were women. Upon the 
island of San Cervilio there is another establishment, for the 
men, of whom the number varies but little from that of the 
women. The patients at the Asylum for the women are di- 
vided into six classes, according to the species of insanity. 
These classes are not kept exclusively separate; on the con- 
trary, some individuals belonging to every one of them may 
be found in the same ward. The colour of a strip of cloth 
attached, as an epaulette, to the shoulder of each patient, is a 
mark by which those belonging to the several classes may be 
identified. The classes are, 1st, mania, distinguished by a 
red colour; 2d, monomania, distinguished by deep blue; 3d, 
melanconico, by green; 4th, idiotismo, by orange; 5th, stu- 
pidita, by light blue; 6th, demenga, by yellow. 

As I was unable to procure all the data which would have 
been desirable, I shall speak of the apartments through which 
we passed, introducing, as appropriate opportunity offers, the 
other information which I possess. 

1st Story. — Bathing-room, dining-room, kitchen, a dormi- 
tory containing many beds, and a room in which about 70 
patients were spinning tow upon a hand throstle, as at Milan, 
and several others knitting and sewing. I noticed several, 
among these, who had the goitre. The room in which these 
were at work is warmed by a stove, which is entirely enclosed 
with bricks and mortar, and surrounded, three or four feet dis- 
dant, by a strong wooden railing. The women were at dinner 
when we went into the dining-room. Their regimen is as 
follows, viz. — Breakfast; bread and soup; — dinner; meat, 
bread, rice, and wine every day, with the addition of potatoes 
or cheese, the two being given alternately. Suspended under 
the corridor, near the door of the dining-room, there was a 
table of the appropriation of time. It is as follows: — 
5* 



54 



Week days. A. M. Sabbath and Feast days. 

Rise and dress, . . . 6| to 7| o'cl. The same. 

Breakfast, 7|to 8 The same. 

Doctor's visit, .... 8 to 9 The same. 

Labour, 9 to 12 10 to 11 o'cl., atttend mass. 

P. M. 11 to 12 " receive visits of friends. 

Dinner, I2§ to 2 The same. 

Study of numbers for play, 2 to 3 Recreation. 

Labour, 3 to 4 Play at Tomboli and religious exercise. 

Supper, 4 to 5 The same. 

Walk, 5 to 6 The same. 

Recreation, 6 to 7 The same. 

2d Story. — The study of the physician, the infirmary, three 
large dormitories, like the wards of hospitals for the sick, and 
two or three small rooms for the accommodation of pay pa- 
tients. The bedsteads are of wood throughout the establish- 
ment. The beds are without curtains. The infirmary is 
large, containing about 30 beds, most of which were occupied. 
It is one of the most complete and elegant apartments of the 
kind that I have seen. The floor is of Mosaic. 

od Story. — A suite of three rooms called " Sicurezza," and 
intended for the most violent patients. They contain about 50 
beds, all of which were occupied. The bedsteads are made of 
plank, similar in form to those at the Asylum at Utrecht, but 
differing from them, in that the bottom is a rack, thus permit- 
ting water to escape in all parts. A large box or trough is 
placed beneath each, to preserve the cleanliness of the floor. 
The patients in this department mostly lie upon loose straw, 
which is covered by a blanket. Many of them were confined 
by having their arms fastened to the sides and their feet to the 
foot of the bedsteads. The rooms in question overlook a por- 
tion of the Adriatic, the Lido and the cemetery of Santo Cris- 
tofero. There is another department in the third story called 
"Osservazione." It is intended for the convalescent patients 
and such as have recently been admitted. The latter remain 
here until the nature of their disease is satisfactorily ascertained. 
This department contains about 30 beds. 



55 



ASYLUM AT MALTA. 

The island of Malta, the rendezvous of vessels traversing 
the Mediterranean, is said to be more populous, in proportion 
to its size, than any other portion of Europe, or, perhaps, of 
the whole world. The number of inhabitants to a square mile 
is five times as great as that of England. Its population, to- 
gether with that of the small island of Gozo, in its immediate 
vicinity, is about 120,000. Of this number there are at pre- 
sent, as nearly as has been ascertained, 130 lunatics, or about 
1 in 900. The only Asylum for the reception and treatment 
of them is at Floriana, in the suburbs of Valetta, the port of 
Malta. It is one of the several benevolent institutions for the 
poor which are under the direction and support of the go- 
vernment. For an introduction to this Asylum, as well as 
to the hospitals and charitable institutions of the island, I am 
indebted to Dr. Gouder, who accompanied me to them, seve- 
rally, and afforded me every assistance in his power to obtain 
such information as was desired. The Asylum is old, and, 
as an almost necessary consequence, very incommodious for 
the present method of treatment. Additions, however, have 
recently been made, and others are in progress; so that, 
eventually, and at a period not very remote, the defects 
will in a great measure be overcome. Baths have recently 
been constructed, the Asylum never previously having been 
supplied with them. The mattrasses of the beds are of straw, 
the most comfortable as well as wholesome material, in a 
climate like that of Malta, even for such patients as other- 
wise might be permitted to lie upon feathers. The bedsteads 
consist of two movable iron stands acting as supports to the 
boards upon which the mattrass is laid. In the morning, these 
stands are placed beside the walls of the dormitory, and the 
direction of the boards changed so as to be parallel with the walls 
instead of at right angles with them. Each mattrass is then 
doubled, or folded once upon itself, and the bed-clothes, folded 
also, laid upon it. This gives a neat aspect to the rooms, and 
leaves a much greater portion of the floor unencumbered than 



56 

is the case with bedsteads of the ordinary kind. Adjacent to 
the building, and partially enclosed by it, are three courts, or 
yards, for the use of the patients. These are not large, but 
they are well cultivated. One of them is planted with orange 
trees, which are large, and, when I was there, were in full 
bearing. Another of the courts is used as a kitchen-garden. 
It is well planted with a variety of vegetables, the labour re- 
quired in its cultivation being performed by the patients. The 
regimen, which has been recently improved, is as follows: — 
Breakfast; coffee and bread; dinner ', which is eaten at mid- 
day, soup, meat and fruit; supper, soup and fruit. 

The number of patients in February, 1839, was 90, of whom 
40 were men and 50 women. There are, at all times, more 
female than male patients. The superintendent informed me 
that he believes the proportionate number of the former to 
the latter to be as 3 to 2. The same ratio, agreeably to his 
opinion, is equally applicable to all the cases of insanity in the 
two islands. 

A very large proportion of the patients perform some manual 
labour. The principal employments are gardening, sewing, 
knitting, spinning, and domestic affairs. Thus far, however, 
there has not been sufficient employment to keep the patients 
so constantly occupied as might be best for their own content- 
ment, or most beneficial in promoting a cure. Amusements 
have not, hitherto, been introduced; and the same remark is 
equally applicable to reading and writing. When punishment 
is necessary, close confinement is the principal resource. For 
this purpose there are several small cells, supplied with no 
furniture, having a grating to the doors, and, for the admission 
of light, a small aperture in the outside wall, so high as to be 
inaccessible to the patient. 

The principles of reform began to enter this institution in 
the year 1812. The use of chains, those implements of con- 
finement and of torture, fit only for criminals and wild beasts, 
was then entirely abolished. Whenever bodily restraint is 
necessary, the camisole or strait-jacket is called in requisi- 
tion. The pattern of this garment of coercion, used in this 
Asylum, is, in my opinion, an improvement upon all others 



57 

which have come under my observation. lis principal pecu- 
liarity consists in two bands, one upon either side, attached to 
its lower border and passing around the legs. The whole 
garment is thus kept more effectually in its proper place. The 
patients have ever been, and still are, mingled together, irre- 
spective of stage or intensity of disease. A division into two 
classes, 1st, the imbecile and the incurable; and 2d, the cura- 
ble, is about to be made. Most of the patients were remark- 
ably quiet. There were, however, two exceptions. The first 
of these was a man at work in the court of orange trees. He 
talked with superlative volubility as long as we would listen, 
the principal burthen of his conversation being a desire to get 
out of the Asylum for the purpose of taking a wife; and, inas- 
much as fifty-four winters had begun to shed their frosts upon 
his brow, he feared that the time would soon arrive in which 
to him, as to Omar, the son of Hassan, it would no longer be 
possible to "marry a wife as beautiful as the Houries and wise 
as Zobiede." The other was a Frenchman, a member of a 
respectable family in France. He assumes to himself the title 
of Prince de Valois; says he has millions of property, and 
can afford to keep a numerous suite of valets. His clothes were 
in tatters. The superintendent informed me that, but a short 
time previously, he had received a good suit from his friends, 
but will not deign to wear them, because, forsooth, they were 
not made by the tailleur du roi — the king's tailor. 

Many of the inmates of this Asylum died of the Asiatic 
cholera, during the ravages of that fatal epidemic in Malta, in 
the summer of 1837. The superintendent could not tell me 
the precise proportion of cures effected here, but thinks that it 
exceeds 50 per cent. 

ASYLUM AT CONSTANTINOPLE. 

Connected with some of the mosques in Constantinople, there 
are buildings for the reception of the sick — a kind of hospital, 
in which the poor who are suffering under disease may have 
their wants ministered to by the hand of charity. That which 
is adjacent to Sulimanye, or the mosque of Suliman, is devoted 



58 

exclusively to the insane. There, none but men are admitted; 
the women, according to the Turkish custom, as well as in 
conformity with the precepts of the religion of Mahomet, being 
kept in private seclusion. The building is but one story in 
height, and, like the cloisters of many gothic cathedrals, and 
the khans or caravanseras of Turkey and Natolia, completely 
surrounds a central court. The entrances to all the rooms are 
beneath the corridor at which the court, upon all sides, is 
limited. 

I visited this Asylum during the feast of the Bairam, near 
the close of the year 1838, in company with two American 
gentlemen, residents at Constantinople. We entered the court, 
passing several miserably clad people, "sitting at the gate," 
not "to ask alms," but to receive it, if voluntarily offered. 
Within the court were many people, mostly young men and 
boys, who had come, either for the gratification of curiosity, 
or to administer to the wants of the afflicted. We passed 
along the corridor to the first window. From between the 
bars of the iron grating with which this was defended, a heavy 
chain, ominous of the sad reality within, protruded, and was 
fastened to the external surface of the wall. It was about six 
feet in length. The opposite extremity was attached to a heavy 
iron ring, surrounding the neck of a patient who was sitting, 
within the grating, upon the window-seat. We entered the 
room and found two other patients, similarly fastened, at the 
two windows upon the opposite side of the room. It was a 
most cheerless apartment. A jug to contain water, and, for 
each of the patients, a few boards laid upon the floor, or ele- 
vated three or four inches, at most, and covered with a couple 
of blankets, were all the articles of comfort or convenience 
with which, aside from their clothing, these miserable creatures 
were supplied. Although in the latter part of December, they 
had no fire; nor were the windows glazed, but close shutters 
attached to each, rendered it possible measurably to shield the 
inmates from severe weather whenever it might occur. The 
length of the chain of each patient is barely sufficient to enable 
him to lie down upon his comfortless bed of boards and blan- 
kets. Leaving this apartment, we proceeded successively to the 



59 

others, twelve or fifteen in number, in all of which we found 
the patients in a very similar condition to those whom we had 
first seen. There was but one who was not chained. He was 
an elderly man, though still retaining much of the vivacity of 
earlier years. His long and profuse hair and beard were nearly 
white, and his complexion very delicate. He was formerly a 
priest of the Islam faith. He has been deranged and confined 
in this place nearly fifteen years, during which time he has 
thrice broken the chain with which he was secured. He is 
now alone in his apartment, within which no one is permitted 
to enter. He talked and raved incessantly, threatening to kill 
those who were making him their gazing stock. Like those 
in the apartment first mentioned, all the patients, with one 
exception, were without fire. The person forming this ex- 
ception was one of the most hideous of undeformed human 
beings. He has been in the Timar-hane, as this Asylum is 
called by the Turks, more than forty years. His hair and 
beard, both naturally abundant, curly, and black as ebony, 
appeared as if they had" not been cut or combed since his en- 
trance. They nearly concealed his face, and the former hung 
in a profusion of literally "dishevelled locks" about his neck 
and shoulders. His head would have been a nonpareil for an 
original to the figure of Cain, in David's celebrated picture of 
"Cain meditating the death of Abel." He lay crouched upon 
all-fours, resting upon his knees and elbows, and holding his 
head and hands over a manghale of living embers. Whatso- 
ever was said, whether addressed to him or otherwise, could 
only induce him slowly to turn his huge head, and present his 
hideous face more directly to view. His case was a striking 
example of dementia. 

The patients, generally, appeared to enjoy pretty good 
health, aside from the lesion producing insanity. I was in- 
formed that a physician attends them regularly. There is a 
person who has the charge of supplying them with food, and 
they receive considerable attention from those who visit them. 
While we were there, many visiters were conversing with 
them, giving them articles of food, money and tobacco, and 
doing them a kind office by filling and lighting their "che- 



60 

bouks." These patients presented a diversity of species of 
insanity, and a variety of hallucinations. One of them was 
seated against the bars of his window, cross-legged, and with 
arms folded upon his breast, in all the counterfeited dignity of 
a sovereign, and the imperturbable gravity of a saint. It was 
evident by his demeanour that he esteemed himself one of the 
rulers of the earth — a Mahmoud, a Mahomet, or a Great Mo- 
gul. Upon being informed that I was an American, * 'Please," 
said he, turning towards me slowly, and without the slightest 
change of countenance, "please, effendi, to give my respects to 
the Sultan of America." This said, he assumed his former 
position, and maintained it with the most scrupulous exactitude. 

There was another, one of the finest looking Mussulmen that 
ever worshipped before the altars of Stamboul. His beard 
might acknowledge no rival in beauty, excepting that of Mah- 
moud the Second, and his eye possessed all the mingled fire 
and softness of the Orient. He was occupied in sewing. He 
was surrounded by several young Turks, but continued his 
labour regardless of any of those who were present. The 
gentleman of our party who speaks the Turkish language ad- 
dressed him, and at length won him, although with consider- 
able reluctance on his part, into conversation. I have never 
witnessed a greater blandness and suavity of manners than in 
him. Upon being asked the cause for which he had come to 
that place, "Please, gentlemen," said he, "to be seated, and I 
will relate the whole history." Inasmuch as the uncovered 
stone floor presented an aspect rather uninviting, as a seat, we 
excused ourselves, and he was requested to proceed. There- 
upon he placed himself in an attitude worthy of the orators of 
antiquity, and related a long story, in a most amusing but 
graceful manner. The whole substance of it was, that people 
began by calling him a fool; and, going from bad to worse, at 
length ended by bringing him to the Timar-hane of Suliman-ye. 

Such, then, is the gloomy picture with which these sketches 
of some of the Asylums for suffering humanity are brought to 
a conclusion. It presents us with an additional motive for 
hoping that the stream of knowledge, which, taking its rise in 
Chaldea, has flowed to us, constantly augmented in its course, 



61 

through Egypt, Greece,, Rome, and the nations of western 
Europe, may reverse its course, or release a branch, once more 
to fertilize the desolate regions of intellect throughout the East. 
It is a proposition, the truth of which cannot, perhaps, be 
questioned, that, in proportion as a nation advances in intel- 
lectual cultivation, its practical benevolence assumes a loftier 
standard. When, then, the light of science shall gild with 
brighter rays the empire of the Ottoman, we doubt not that the 
chains of the maniac will be broken, and his condition ren- 
dered such as to leave a hope, that alienated reason may reas- 
sume her proper throne. 

It is difficult to reconcile the treatment of the patients in the 
"Timar-hane" with the testimony of physicians in regard to 
the attention paid to unconfined lunatics in Turkey, and with 
the prevalent opinion among the followers of Mahomet, that 
the insane are the especial favourites of Heaven — that their 
"discord" is 

''harmony not understood;" 

that their language appears to us to be incoherent and unmean- 
ing, merely because the minds of the sane are not sufficiently 
spiritualized to comprehend it. Dr. Millengen, an English 
physician who had practised nearly twenty years in Constan- 
tinople, informed me that he had known the wandering lunatic 
to be received by strangers, and, for weeks in succession, re- 
ceive all the kindness of the most cordial hospitality. 



62 



ASYLUMS IN ENGLAND. 

In the year 1815, the British Parliament passed a law, by 
which each of the several counties of England was authorized 
to erect an Asylum for the insane. As the provisions of this 
act were not compulsory, the counties have been slow in com- 
plying with them. At the present time, sixteen institutions, 
constructed in conformity with this law, are in operation. 
They are in the counties of Middlesex, Bedford, Chester, Lei- 
cester, Gloucester, Stafford, Norfolk, York (West Riding), 
Nottingham, Lancaster, Oxford, Lincoln, Kent, Suffolk, Dorset 
and Cornwall. There is one in progress in the county of 
Surry. Of the above mentioned Asylums, an account of that 
of Middlesex, at Hanwell, and that of the West Riding of 
York, at Wakefield, have already been given. Our informa- 
tion in regard to the remainder is neither extensive nor minute. 
It is comprised in the following notices. 

BEDFORD ASYLUM. 

This Asylum, opened in 1812, accommodates 52 patients, of 
whom the convalescents assist in gardening during the warm 
season. The original expense was more than 10,000 pounds. 

GLOUCESTER ASYLUM. 

Subscriptions were raised, more than forty years since, for 
the establishment of a charitable institution for the insane in 
Gloucester, but after the act was passed authorizing the con- 
struction of county Asylums, the amount thus raised was 
added to the public fund, and the present building erected. It 
cost, with the grounds, 44,457 pounds, 6 shillings, and was 
opened in July, 1823. It accommodates 120 patients. The 
patients assist in gardening, farming and household labour, 
which, according to one of the reports, "is found not only 
most useful to themselves, but, also, most beneficial to the 
establishment." 



63 



STAFFORD ASYLUM. 

The Asylum at Stafford was opened in October, 1818. It is 
said to be a well conducted establishment. The number of 
patients in 1826 was 155. A report at that time says, "The 
cultivation of thirty acres of pasturage, pleasure and garden 
ground, is performed entirely by the patients, assisted by two 
of the keepers; and all the making of linen, and mending of 
clothes, is done by the females." The weekly expense of 
each patient is about 9 shillings sterling. 

NORFOLK ASYLUM. 

This institution can accommodate about 120 patients. The 
cost of the establishment was 35,221 pounds. 

NOTTINGHAM ASYLUM. 

This Asylum, situated at Nottingham, was constructed at an 
expense of 20,350 pounds, and opened in February, 1812. It 
accommodates eighty patients, of whom the labouring portion 
among the males are employed in gardening. 

LANCASTER ASYLUM. 

This Asylum is situated about a mile from the town of Lan- 
caster. It was opened for the reception of patients on the 
2Sth of July, 1816. It has accommodations for 360. The 
cost was 59,833 pounds. The original tract of land belonging 
to the establishment was fifteen acres, but, I believe the farm 
has been considerably increased. Some of the patients labour, 
the women at sewing, knitting and domestic duties; the men 
at gardening and husbandry. 

LINCOLN ASYLUM. 

This Asylum is at Lincoln. It was opened in April, 1820. 
It was originally intended for about fifty patients, and was 



64 

completed at an expense of 12,405 pounds sterling. Some of 
the patients are employed in household work and gardening. 
I know not that the buildings have been enlarged. 

CORNWALL ASYLUM. 

This institution is pleasantly situated, and the airing grounds 
are said to be extensive. It was opened in October, 1820, with 
accommodations for 102 patients. The original cost was 
15,724 pounds, 14 shillings and 8 pence. In speaking of the 
inmates, a report says, "They work in the garden, and raise 
water for the use of the house by means of a wheel pump. 
The female patients also work in the garden and assist the 
laundress." 

Besides the County Asylums, there are many institutions 
established by subscriptions and donations. Of these, the "Re- 
treat," at York, has already passed under observation; of the 
others, we proceed to notice those of which we possess any 
information. 

BETHLEHEM ASYLUM, LONDON. 

The Bethlehem Asylum, generally called "Bedlam," in 
England, and referred to by Pope, in the line 

"All Bedlam or Parnassus is let out," 

is one of the oldest institutions for the insane in Great Bri- 
tain. The original building was in Finsbury, on the north 
side of the Thames; but new edifices, imposing in their exter- 
nal appearance, were erected in 1812 on the south side of the 
river. 

When in London, I went to this Asylum, and was disap- 
pointed in learning that no one is admitted, as a visitor, except 
by special permission from one of the directors. An almost 
immediate departure from the city prevented me from obtain- 
ing such permission. 

Sir Andrew Halliday, in speaking of this institution, in 



65 

1828, says, it "is now well conducted, and the patients are 
humanely and judiciously treated; but it has still too much of 
the leaven of the dark ages in its constitution, and too rigid a 
system of quackery is maintained, in regard to its being seen 
and visited by respectable strangers, and there is too little 
space for exercise and employment, for it ever to prove an 
efficient hospital." 

A more recent writer observes, "Little has been done for 
the purpose of employing the patients, and diverting their 
minds from the subjects of morbid thought. We do not re- 
member to have seen either work-shops for manual labour, or 
a reading-room, or games of amusement. The grounds, 
though large for an institution located in a city, are too con- 
tracted for so great a number of patients."* 

This Asylum has a permanent income of about 90,000 dol- 
lars per annum, and receives, from government, an additional 
sum of 13,000 dollars, for the support of criminal lunatics. 
These patients are kept in wards, devoted exclusively to 
themselves. The number of patients, at Bethlehem, in 1840, 
was 429. 



This Asylum is in the northerly part of London. It was 
founded by subscription, and has been in operation nearly a 
century. During the last eighty years, the number of admis- 
sions was 16,5S9. Of these, 5S per cent, were cured. The 
average expense of the patients is $2,50 per week. Epilep- 
tics, paralytics, idiots, those who have been deranged more 
than one year, those who are under twelve years or over se- 
venty years of age, and those who are able to support them- 
selves, are not admitted. It is said that this Asylum is better 
conducted than the one last noticed, although useful labour 
and judicious amusements have not entered so fully into the 
plan of treatment as is desirable. 

* Review of Ferrus on the Insane. Am. Journal of the Medical Sciences. 
Mav, 1837. 
6* 



66 



ASYLUM AT NORTHAMPTON 



The cost of this establishment, including twenty-four acres 
of ground, was 24,000 pounds. Parish paupers are maintain- 
ed here at an expense of 9 shillings sterling per week — others 
pay from 3 dollars to 5 dollars. — "Eighty-three per cent, of 
all the patients are employed, and ninety-four per cent, of the 
male patients. The non-resisting principle is applied here in 
its ultra form. In one instance, the day I was there, the bed 
and bed-clothes of a patient were completely changed, four 
times, between eight and twelve o'clock, a warm bath prepar- 
ed each time, and the patient washed, and her clothes changed 
throughout, rather than use severe measures for correcting or 
counteracting her propensities. — The superintendent of this 
institution, (Dr. Pritchard,) is passionately devoted to his 
duty."* 

ASYLUMS IN SCOTLAND. 

ASYLUM AT MONTROSE. 

This Asylum has been in operation many years. I have 
not obtained the statistics of the institution, nor am I aware of 
the extent of its accommodations. The superintendent, Dr. 
Poole, in his report for 1840, approves of the abolition of all 
bodily restraints, in the treatment of the insane, in those insti- 
tutions which are provided with the "essential requisites" to 
such a mode of treatment. "But in the absence of some of 
them," says he, in speaking of the Montrose Asylum, "and at 
variance with my own creed, I must tolerate the occasional 
imposition of hand-cuffs, to prevent greater evils than they 
inflict. Mr. H.,t I am persuaded, would not blame me, under 
circumstances, for departing from the true faith, inasmuch as, 
e. g., I pinioned one man because, having an ulcerated leg, 

* "Memorandum of a late Visit, &c." by F. A. Packard. 
t Gardiner Hill, of Lincoln, an advocate for the abolition of all physical 
restraint. 



67 

which needed poultices and ointment, he repeatedly tore off 
and actually swallowed them; or that, with a latitudinarianism 
not deemed heretical in a pure physician, I had another tucked 
down to bed till the turbulence of delirium tremens yielded to 
a potent opiate; or even that, with only one female attendant 
to twenty of her sex, I permit the temporary confinement of a 
couple of arms, which would both reduce their possessor to nu- 
dity and dispense merciless blows to all around." 

ROYAL LUNATIC ASYLUM AT GLASGOW. 

This is an institution of very high standing, but we have 
but little information in regard to it. The wings of the build- 
ing are three stories in height: the pauper patients being in 
the first, the lowest class of pay patients in the second, and 
the highest in the third. 

ASYLUM AT EDINBURGH. 

This was founded by voluntary subscription, and no patient 
is received under a guinea a week. 

ASYLUM AT ABERDEEN. 

This institution was erected by subscription. It will ac- 
commodate about 100 patients. It is said to be well conducted. 
There are also Asylums at Perth, Dundee, and Dumfries. 

ASYLUMS IN IRELAND. 

An act of parliament, in 1817, authorized the lord-lieutenant 
of Ireland to direct the "magistrates of any county or district 
to erect an asylum for the accommodation of their insane 
poor." These asylums are under the general superintendence 
of two individuals, called inspectors general, who are obliged 
to report, annually, to parliament. They are empowered to 
inspect private as well as public asylums. 



68 



RICHMOND ASYLUM AT DUBLIN. 

This asylum is calculated for about 300 patients. It was 
begun in 1S10, and cost £77,809 5*. 9\d. sterling. In 1S27 
it contained 277 patients, of whom 130 were usefully employed 
in gardening, needlework, washing and other housework, 
weaving, tailoring, &c. Twelve were learning to read. 
During the year "3188 hanks of yarn were spun; 406 pairs of 
men's and 349 pairs of women's stockings knitted: and, of 
linen woven in the establishment, there were made, by the 
female patients, for the use of the inmates, 140 shirts, 180 
shifts, 115 bolster-cases, 56 pairs of sheets, 53 rollers, 83 bo- 
dices, 80 nightcaps, besides keeping in repair the whole cloth- 
ing of the male and female patients." 

WORKHOUSE ASYLUM, DUBLIN. 

A department of the workhouse, at Dublin, is devoted to 
insane paupers. It generally contains from 500 to 600 pa- 
tients. I visited this in the summer of 1837, but took no 
notes. The patients appeared to have very comfortable ac- 
commodations. 

ASYLUM AT WATERFORD. 

This is connected with the house of industry. In 1827 it 
contained 4S idiots and 57 lunatics. The report of the inspec- 
tors states that "the patients are treated with lenity, and there 
was but one patient coerced, a male lunatic, on whom a strait- 
waistcoat was placed." 

ARMAGH DISTRICT ASYLUM. 

This establishment has 13 acres of land, and accommodates 
106 patients. The original cost was £20,900 4s. 5d. It was 
opened in 1825. The patients are employed in gardening and 



69 

other manual labour. They weave all the linen for the use of 
the house, and make the clothing for themselves. 

ASYLUM AT CORK. 

This is a well conducted institution, having accommodations 
for more than 300 patients. 

ASYLUM AT LIMERICK. 

This was opened in 1827, having been erected at an expense 
of ^29,511 10s. Sd., inclusive of the cost of 12 acres of land. 
It is calculated for 150 patients, and a is one of the best arranged 
public asylums that has ever been built." 

ASYLUM AT LONDONDERRY. 

This institution can accommodate 106 patients. 

There are public asylums at Belfast, Kilkenny and Wex- 
ford, and several smaller ones in other places. There are also 
four private establishments in the vicinity of Dublin. 

ASYLUMS IN HOLLAND AND BELGIUM. 

To the notices already given of Asylums in the Netherlands, 
we shall only add the following: 

COMMUNITY ASYLUM AT GHEIL. 

Gheil, a commune containing nearly 7,000 inhabitants, is 
situated about twenty-seven miles from Antwerp. According 
to a local tradition, an English lady of rank and beauty, being 
"driven to madness by the treachery of a lover, and the 
cruelty of friends, wandered from her home and from her 
country, and found refuge in this secluded spot, where she 
recovered her reason, built a church, and devoted a long life 
to curing the insane, having received from Heaven the power 
of performing such cures." From that time until the present 
the village of Gheil has been the place of resort for thou- 
sands of the insane, and, although the English lady no longer 



70 

lives, to minister to the afflicted, yet she has been canonized 
under the title of Saint Nymphna, and still is made the presi- 
ding saint of the village and the commune. Some stones, said 
to be the remains of her sarcophagus, are preserved, being 
placed upon pillars adjacent to the church which she caused to 
be erected. For a long period, every new patient was confin- 
ed nine days, in a solitary room, and, at three times during 
each day, joined a procession which marched several times 
around the church, at each time passing under the relics of the 
sarcophagus, repeating a prayer to the saint, that she would 
condescend to effect his restoration. This custom is now 
nearly or entirely abolished. 

The number of lunatics in this commune, in 17S9, was 400; 
in 1803, 600; in 1812, 500; and in 1821, 400. No resident 
is permitted to have more than five patients, at one time, in 
his house. Those patients whose condition will admit, are 
obliged to work a certain number of hours during the day, 
and then are permitted to ramble at their pleasure, being sum- 
moned home by the ringing of the bell of the village church. 
Of the 400 patients who were there in 1821, about 100 were 
of this class, and 50 of them worked at agriculture. It is said 
that escapes have been frequent. The patients, when quiet, 
are treated kindly, but if mischievous or furious, they are 
chained at the wrists and ancles. In every house, there is a 
ring beside the chimney, or attached to the beds, to which 
they may be chained. Esquirol says he saw one man, from 
whose legs the skin had been abraded by the iron surrounding 
them. 

While the superstitious belief in the supernatural powers of 
Saint Nymphna remained unshaken, the proportion of cures 
at Gheil was said to be very great, many of them being effect- 
ed during the preliminary nine da}^s of probation and devo- 
tion. But since this faith has been lost, the charm is broken, 
the number of cures is but small, and the place has become 
rather an asylum for incurables, than a place for judicious 
curative treatment. The mortality among the insane is said 
to be a little greater than among the residents of the com- 
mune. 



71 



ASYLUMS IN FRANCE. 

Nearly all the insane, in France, are placed in public in- 
stitutions; some of them being in special Asylums, others 
in hospitals, alms-houses, houses of correction, and prisons. 
Their condition has been very much ameliorated since the 
commencement of the present century. 

In 1818, there were but eight establishments, throughout 
the whole kingdom, exclusively devoted to the reception of 
persons labouring under mental disorders. But, between that 
period and 1837, the number was augmented to thirty-four. 
In a few of these, however, some other persons are received. 

Three of the largest and most important of these institu- 
tions, La Salpetriere, Le Bicetre, and the Maison Royale 
d'Alienes, at Charenton, have already received a somewhat 
elaborate notice. Of the others, the following are the most 
important. 

ASYLUM AT AVIGNON. 

This Asylum has been in operation many years. Since the 
commencement of the present century, it has been greatly 
enlarged and improved. It is said to be well conducted and 
remarkable for its neatness, but the relics of by-gone time 
still remain, in the bolts upon the doors of the patients' rooms. 

SAINT-YON ASYLUM, AT ROUEN. 

This is one of the best institutions of the kind in France. 
It was opened in July, 1825. The buildings are constructed 
according to the plan of Esquirol, being but one story in 
height. The number of patients, on the 31st Dec. 1834, was 
455, of whom 221 were men, and 234 women. From 1825 
to 1834, inclusive, 1438 patients were admitted. Of these, 
737 were men and 701 women. In 1832, two men and eleven 
women died of the Asiatic cholera. The price of board, &c. 
for patients, varies from 350 to 1500 francs, per annum. 



72 



COUVENT DE FORCE ASYLUM, AT BORDEAUX. 

This Asylum is pleasantly situated, in the vicinity of the 
city of Bordeaux. It was formerly a prison, with a depart- 
ment for the insane; but, since the year 1803, it has been de- 
voted exclusively to the latter. The rooms are large, and the 
buildings but one story in height, enclosing courts. The 
institution is under the "immediate surveillance of the Sisters 
of Charity," who make mildness, benevolence, and humanity 
reign throughout. The medical department is under the care 
of a physician, assistant physician, and two surgeons. The 
pay patients have w T ine, daily. Their dishes are of earthen, 
while those of the indigent are of tin and block-tin. In 1817, 
the number of patients was 125; of whom 47 were men, and 
78 women. 

At Cadilhac, about 15 miles from Bordeaux, there is an 
inferior Asylum, where, in 1835, there were 209 patients. 

ASYLUM AT MONTPELIER. 

This was opened for men, in 1822, and for women-, in 1824. 
Since that time, it has been very much enlarged and improved. 
In December, 1835, it contained 138 patients, 75 of whom 
were men, and 63 women. 

ASYLUM AT MARSEILLES. 

This establishment w r as formerly a general hospital. It was 
much enlarged in 1816, and at subsequent periods. The recent 
buildings are three stories in height, with dormitories on each 
side of a central gallery. From 1797 to 1818, there entered 
345 men, and 351 women: total 696. In 1819, the number 
of patients in the Asylum was 119. 

A large and commodious establishment, with accommoda- 
tions for 300 patients, has recently been erected, near Mar- 
seilles. 



73 



ASYLUM AT AIX. 

This is an inferior establishment connected with the alms- 
house. The furious patients are chained, by the legs, to the 
walls of the cells. 

ASYLUM AT LYONS. 

A part of this establishment was formerly a convent. It is 
situated upon the declivity of a hill, in the vicinity of the city. 
Drs. Martin and Bottex have charge of the medical depart- 
ment, the latter of whom delivers clinical lectures on mental 
disorders. The regimen of the patients is as follows: At 8 
o'clock, A. M., bread and cheese; at 12 o'clock, M., soup, 
meat and bread; 4 o'clock, P. M., vegetables, fruit and bread. 
Each patient is allowed one and a half pounds of bread per 
diem; each of the pay-patients, four ounces of meat, and each 
of the paupers, two ounces. On four days in the year the 
rations are doubled. 

HOSPICE DE LA PROVIDENCE, AT SAUMUR. 

This singular Alms-house is situated on the declivity of a 
rocky hill. The following description of it is abridged from 
Esquirol. After ascending a staircase and a rocky acclivity, 
the visiter comes to a place where a great number of small cells, 
or lodges, are excavated in the rock. Some of these are large 
enough to contain several beds — the bedsteads, in some instan- 
ces, being the rock itself. In these cells are maniacs, quiet luna- 
tics, and some superannuated men who pay their board. At 
some distance from these cells is a large cavern, 260 feet in 
length, 26 in width, and 16 in height, also cut in the rock, as is 
the vestibule at its entrance, which is occupied as a working 
room. This large cave is furnished with three ranges of beds, 
occupied by more than sixty imbecile, demented, epileptic and 
paralytic women. Light is admitted through a large circular 
aperture in the middle of the roof of the cavern. Adjacent to 
7 



74 

this large room are numerous smaller ones, occupied by such 
patients as require to be isolated. Farther on are two more, 
even larger than the largest heretofore described. These 
unique halls for the insane are said to be dry, and the patients, 
having exercise and a good regimen, are said to enjoy as good 
general health as at other asylums. The number of insane is, 
generally, from 70 to 80; the whole number of inmates, about 
300. Dr. Gaulay has the medical charge of the institution. 

ASYLUM AT ARMENTIERES. 

This is a large establishment; the buildings, which were 
erected before the French revolution, being constructed around 
an oblong court. It is for men alone. 

BON-SAUVEUR ASYLUM, AT CAEN. 

This was a convent, founded in 1720. It was enlarged in 
1805, and in 1818 it was first opened for the insane. It is an 
extensive establishment, having three distinct departments for 
the insane men. 1st, for the quiet; 2d, for the idiots, epilep- 
tics and the demented; 3d, for the furious. The department 
for women is about 600 feet long, and three stories in height. 

In each section, there is a room supplied with baths and 
douches, several common halls, and rooms for the working 
patients. There is a chapel, a library and a billiard -room. 
The patients work in the garden. The number of patients, in 
July, 1833, was 300; from that time to January 1st, 1835, 
there were 122 admissions. Of these 422 patients, 199 were 
men and 223 women. 

ASYLUM AT RENNES. 

This was, formerly, the Saint-Maen hospital. It has been 
devoted to the insane but a few years; the nurses are Sisters of 
Charity. Cider is given to the paupers, and wine to the pay- 
patients. 



75 



ASYLUM AT TOULOUSE. 

This is an old establishment, in which both lunatics and pri- 
soners were formerly confined. In 1819, the prisoners were 
removed, the dungeons destroyed, and large rooms erected; 
and, in 1826, an ancient convent was added to the establish- 
ment. Although the condition of the patients has been much 
improved, yet great ameliorations remain to be eftected. The 
number of patients, in 1836, was 293. 

ASYLUM AT NANTES. 

This is attached to the Hospice de Saint Jacques. It was 
built in 1832. "The first thought," says Esquirol, "of the 
physician, Dr. Bouchet, who has so admirably organized the 
service of this house, and that which governs all his views of 
treatment, has been to subject the patients to order and disci- 
pline, and to furnish them with all kinds of labour of which 
they are capable. For their encouragement he allows them a 
recompense. Hence, there are few Asylums in which a greater 
proportion of the inmates work, or where they appear to enjoy 
greater liberty." In 1835 there were 207 patients, of whom 
172 were employed in manual labour. The number of patients 
at the commencement of 1835, together with the admissions 
during that year, was 277, of whom 123 were men, and 154 
women. 

ASYLUM AT AURILLAC. 

This Asylum is attached to the Civil Hospital. It was founded 
in 1836. It is a fine establishment, built upon the plan of 
Esquirol. There are eight series of buildings, one story in 
height, each series enclosing a square court. Four series are 
devoted to the men, and four to the women; and between these 
two departments is a building containing parlours, bath-rooms, 
and an office for the physician. There are accommodations for 
200 patients. The service, in the wards, is performed by the 



76 

Sisters of Charity. In front of the establishment is a beautiful 
lawn, ornamented with a fountain, and planted with five thou- 
sand mulberry trees. 

ASYLUM AT LAFOND. 

This Asylum Was opened in December, 1829. It is well 
constructed, with parlours, rooms for labour, and covered pro- 
menades. In each court there is a fountain. There are ac- 
commodations for 200 patients, of whom each class may be 
kept entirely distinct from the others. 

ASYLUM AT POICTIERS. 

This was opened in 1821; it is under the care of Dr. La- 
marque. In 1826 it contained 56 patients. The pay-patients 
are furnished with wine. 

M. Esquirol has an admirably conducted private Asylum 
at Paris. 

In Bavaria and Saxony, the asylums are said to be well ap- 
pointed, and conducted in an enlightened manner. "One of 
the most perfect establishments in Europe is at Wurtzburg." 
In Prussia, also, these institutions are of a superior order. In 
Sweden, the asylums have been much improved; but it is said 
that little is attempted towards curing the mental disease of 
the patients. Denmark is incompletely furnished with asy- 
lums, but those of Copenhagen are well conducted. One of 
the best asylums in the world is at Seigburg, on the Rhine. 
It is under the care of Dr. Jacobi. We have seen no notice 
of any institution for lunatics in Spain, excepting one at Sa- 
ragossa, and of a large one at Madrid; and that of Lisbon 
is the only one which we know to exist in Portugal. The 
asylums of Hesse are very inferior. In that of Hanover, 
"the madman and the idiot are shut up with the thief and 
the murderer;" and in that of Celle u may be found every 
gradation of human wickedness and of human infirmity, with 
only this difference, that the depraved and the criminal part of 
its inmates are treated with some kindness and attention, while 



77 

the diseased and afflicted are left in utter wretchedness and 
neglect." An asylum at Geneva, which was opened in 1837 
or 1838, is the only one we know of in Switzerland. There 
are large asylums at Vienna and Munich, and one at Pirna, 
near Dresden. 

ASYLUMS IN ITALY. 

The most important establishments for the reception and 
treatment of the insane, in Italy, are those of Turin, Genoa, 
Milan, Reggio, Florence, Bologna, Venice, Aversa and Paler- 
mo. Two of them have already been noticed, in detail; and 
of that at Reggio, it has been remarked that Esquirol consi- 
ders it the best of the many institutions which he has visited. 

ASYLUM AT TURIN. 

This is an extensive establishment, under the medical care 
of Drs. Bertolini and Bonacossa. The number of patients, 
January 1st, 1837, was 361. During the six and a half years 
next preceding that date, the number admitted was 1066, of 
whom 650 were males, and 416 females. The species of in- 
sanity of 1048 of these was as follows, viz.: mania, 206; de- 
mentia, 238; monomania, 238; lipemania, (tristimania of Rush) 
266; idiocy, 56; acute delirium, 44. 

Ages at the time of admission. 





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49 272 342 222 104 41 7 29 1065 
Number in six semi-decades. 



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183 159 151 127 121 95 

7* 



78 

Of 945 patients, the disease of 646 is attributable to physical, 
and 299 to moral causes. 

Specific physical causes. — Hereditary 133; diseases and 
injuries of the head and brain, 85; intemperate drinking, 76; 
epileptic, 35; abuse of mercury, 2S; diseases of the abdominal 
viscera, 27; insolation, 19; syphilis, 18; suppression of anor- 
mal discharges, 15; excessive venery and masturbation, 14; 
diseases of the chest, 12; excessive fatigue, 12; disordered 
menstruation, diseases of the uterus, pregnancy and parturi- 
tion, 54. 

Specific moral causes. — Poverty and distress, 124; love, 
35; domestic trouble, 22; religion, 21; jealousy, 19; reverses 
of fortune, and disgrace, 18; terror and fright, 17; protracted 
study, 7. 

Total of cures, discharged, 466; total of deaths, 328. 

Wine is used, as a drink, by all the classes of patients in this 
asylum. 

ASYLUM AT AVE USA. 

This institution is situated about ten miles from Naples. 
Our knowledge of its arrangement, organization and success is 
very imperfect. The physician, Dr. G. Lostritto, has pub- 
lished a summary of 1725 patients, who were admitted during 
the interval of ten years, from 1814 to 1S24. Of these, 783 
were monomaniacs. A greater number of patients were re- 
ceived in 1822 and 1823 than in any other equal period of 
time, owing to the revolution and the popular commotions of 
the time. Dr. L. concludes, from his observations, that there 
are more attacks of insanity in summer than in winter, — that 
there are a greater number between the ages of 20 and 30 than 
during any other period of equal duration in life, — that the 
disease frequently arises from fevers, particularly intermittents, 
but "generally from moral causes/' — that mania is more easily 
cured than any other form of insanity, — that more recoveries 
take place in April than in any other month, — that in the 
Neapolitan vicinity, as well as throughout Italy and Spain, 
there are more insane men than insane women. 



79 
i 

The mortality during the period mentioned was about one 

in four, or 25 per centum; and the principal diseases causing 

death were febrile exanthemata^, dry gangrene, and cachectic 

diseases. 

ASYLUM AT GRAND CAIRO, EGYPT. 

The following interesting account of a visit to this Asylum 
is from Dr. Madden's "Travels in Turkey." 

"I believe that no eye hath witnessed, elsewhere, such a 
melancholy spectacle as this place affords. The keeper made 
many objections to my admission; he said no Frank was suf- 
fered to go in, but the name of the hakkim of the English 
Consul, and the sight of half-a-dozen piastres to boot, removed 
his scruples. 

"I was led from one passage to another, door after door was 
unbarred, the keeper armed himself with a courbash, a whip 
made of one solid thong of the hippopotamus, and we at length 
got into an open court, round which the dungeons of the luna- 
tics were situated. Some who were not violent were walking, 
unfettered; but the poor wretches in the cells were chained, by 
the neck, to the bars of the grated windows. The keeper went 
round, as he would in a menagerie of wild beasts, rattling the 
chain at the window, to rouse the inmates, and dragging them 
by it when they were tardy in approaching. One madman, 
who spat at me as I passed his cell, I saw the keeper pull by 
his chain, and knock his head against the bars till the blood 
issued from his nose. I forced him to desist. Each of them, 
as we passed, called out for food. I enquired about their al- 
lowance, and, to my horror, I heard that there was none except 
what charitable people were pleased to afford, from day to day. 
It was now noon, and they had had no food from the prece- 
ding morning. Two well dressed Turkish women brought in, 
while I was there, a large water-melon and two cakes of bread; 
this was broken in pieces and thrown to the famished creatures. 
I never saw nature subdued to such lowliness. They devoured 
what they got like hungry tigers, some of them thrusting their 
tongues through the bars, others screaming for more bread. I 



so 

sent for a few piastres worth of bread, dates and sour milk; its 
arrival was hailed with a yell of extasy that pierced the very 
soul. I thought that they would have torn down the iron bars 
to get at the provisions; and in spite of the courbash, their 
eagerness to get their portions rendered it a difficult matter to 
get our hands out of their clutches. It was humiliating to 
humanity to see these poor wretches tearing their food with 
their filthy fingers. Some of their nails were so long as to 
resemble the talons of a hawk. 

"And can such be the condition of 'man, so noble in reason, 
so infinite in faculties, in form and movement so express and 
amiable!' Vain boast! Go, paint the faculties of this 'paragon 
of animals' in the dungeons I have described; and when you 
have studied the institutions of the Turk, sit down, if you 
can, with an exalted opinion of human nature. 

"There was one thing that I could not help remarking; the 
ruling passion of the Mahometan, as preserved even in insanity. 
One man, who begged me to give him bread, spat upon me 
when he got it; another, with all the eagerness of famine, ab- 
stained from eating it; hungry as he was, he preferred flinging 
the portion of melon he had just received at a christian's head, 
rather than satisfy his craving stomach. He concealed his 
missile for nearly a quarter of an hour, till I was opposite his 
window, he then thrust his naked' arm through the bars and 
took deliberate aim at me. In spite of my entreaties he got 
the courbash around his uncovered shoulders. But there was 
one old man who moved not while the food was distributing: 
and as I looked into his cell, destitute of every thing, with 
neither straw nor rug, I could barely distinguish an emaciated 
form lying on the bare earth, with hardly a rag upon his body. 
He could not lie down altogether, for he was chained by the 
neck to the window. He was worn to a skeleton; and whether 
it was the pressure of the chain that impeded respiration, or 
not, I cannot say, but his stentorious breathing resembled that 
of a person in the last convulsions; and, on enquiry, I found 
this wretched creature to be actually dying. The smell of the 
apartment was horrible. I had some difficulty to prevail on 
the keeper to take, off his chain; I gave some piastres to buy 



81 

straw, and some days afterwards sent the janizary to enquire 
after the poor wretch: — he was dead, and there was no straw 
to be seen in his dungeon. 

"I observed a very decent looking Turk, in one of the cells, 
who had been an officer in the pasha's troops. He complained 
bitterly of hard usage, and said he was famished; some days 
he had only five para's worth of bread, or a half-penny's worth, 
and he talked altogether so rationally of his condition, that I 
expressed my wonder to the keeper that he was not permitted 
to go abroad. The keeper laughed at my ignorance. 'You 
don't know,' said he, 'that when mad people appear most 
quiet they are always plotting mischief.' He illustrated his 
assertion by a story which, if credible, certainly shewed the 
necessity of confining lunatics, however mild in their appear- 
ance, to the cells at night. 

"A black man, who followed the trade of a butcher, had 
been confined there many years ago; he had been allowed the 
range of the house, with two or three others whose derange- 
ment was attended with no violence. One night the black 
butcher secreted a knife: he induced another man to enter his 
cell, prevailed on him to lie down, and then cut his throat; 
he calmly cut him in quarters, and distributed the joints around 
his cell, as he was in the habit of arranging his meat in his 
shop. He solicited the custom of his comrades, and to those 
who were chained, he carried such portions as they desired. 
The keeper was disturbed by the cannibal rejoicings; it was the 
first full meal they had had for many a long day. On examin- 
ing the cells, he found one man missing. He asked the black 
butcher if he had seen him, and he replied that he had sold 
the last joint of him. 'Since that time,' said the keeper, 'we 
look out better, otherwise they would eat one every day.' 

"I endeavoured to ascertain the cause of the madness of the 
present inmates. They were thirteen in number, and all males. 
Four of them had gone mad from smoking hachis, an intoxi- 
cating drug, composed of the small pistils of the flax plant; 
five of them had had poison administered to them; three were 
religious monomaniac fanatics, and one had gone mad after 
being bastinadoed. 



82 



ASYLUMS IN THE EAST INDIES. 

It appears that previous to ISIS there were hospitals for the 
insane in the British East Indies, but they were very badly- 
conducted. In the year mentioned, an improvement was 
made, by placing at the head of each an experienced British 
physician. These asylums are under the general supervision 
of the judges of the circuit courts; but the immediate govern- 
ment of each is confined to the magistrates of the district in 
which it is situated. The asylums are all built at the expense 
of government. The following are in Bengal: 

ASYLUM AT CALCUTTA. 

The average number of patients in this establishment is 170. 
During the year 1820, the number of admissions was 110, 
cures 73, deaths 21. 

ASYLUM AT DACCA. 

The average number of patients at this asylum is 36. The 
admissions, in 1820, were 32, cures 11, deaths 8. 

ASYLUM AT MOORSHEDABAD. 

In 1820, the number of admissions was 68, that of discharges 

6S. The average number of patients is 55, the average annual 

number of deaths 9. 

4 

ASYLUM AT PATNA. 

There were 11 admissions, 12 discharges, and 2 deaths at 
this institution in 1820. The average number of inmates is 45. 

ASYLUM AT BENARES. 

The number admitted to this asylum in 1S20 was 31, that 
of discharges 9, of deaths 12. Average number of patients 75. 



83 



ASYLUM AT BAREILLY. 

In 1820, 4S patients were admitted, 29 discharged, and 10 
died. The average number of patients is 100. 

Within the government of the presidency of Fort George, 
there are, at least, four asylums for the insane. These are at 
Madras, Chittoor, Trichonoply, and Masulipatam. Of these 
we have no statistics; but that at Madras, it is said, "sur- 
passes many of the European establishments that have long 
been considered as the most perfect of their kind." Within 
the government of Bombay, but one asylum is mentioned. It 
is at Colabah. 

ASYLUMS IN THE UNITED STATES OF AMERICA. 

The institutions for the insane in this country may properly 
be arranged in four several classes. 1st. State Asylums. 2d. 
City Asylums. 3d. Institutions founded by subscriptions, and 
under the care of a board of managers. These may be desig- 
nated Corporate Asylums. 4th. Private Asylums, or those 
belonging each to one or two persons. These institutions will 
be designated here by the name by which they are generally 
known. 

STATE ASYLUMS. 

MAINE INSANE HOSPITAL AT AUGUSTA. 

Cyrus Knapp, M. D., Superintendent 

Chauncey Booth, Jan., M. D., Assistant Physician. 

This Asylum was but recently completed. It went into 
operation October 14th, 1840. The farm contains seventy 
acres. The edifice consists of a central building and wings, 
and will accommodate 120 patients. It is pleasantly situated, 
upon the eastern shore of the Kennebeck river. Although a 
state institution, two benevolent individuals contributed ten 
thousand dollars each towards its foundation. 



84 

The first annual report of the directors of this Asylum has 
very recently been published. From this, it appears that, 
from the time of opening to the close of the year 1840, a period 
of two and a half months, 30 patients were admitted. Of 
these, 22 were men and 8 women; 22 were old cases, or those 
of more than one year in duration, and 8 were recent, or of 
less than one year in duration. 

Religious Worship. — Evening prayers are held regularly, 
and attended by most of the patients. Weekly religious exer- 
cises, on the Sabbath, are about to be introduced. 

Labour. — Many of the men cut wood, and work at carpen- 
try and other kinds of labour. A portion of the women are 
engaged in domestic occupations. 

Amusements. — Nothing is said, in the report, in regard to 
these, excepting the remark that many of the patients are fond 
of reading. 

NEWHAMPSHIRE STATE LUNATIC ASYLUM AT PORTSMOUTH. 

An appropriation for this institution has been made by the 
legislature of the state, and its location determined upon. 
Measures have been taken for the prosecution of the enter- 
prise; and George Chandler, M. D., assistant physician to the 
Massachusetts State Lunatic Hospital, has been invited to 
superintend the erection of the buildings, with a prospect of 
taking charge of the institution when it shall go into operation. 

VERMONT ASYLUM FOR THE INSANE AT BRATTLEBORO. 

William H. Rockwell, M. D., Superintendent. 
Chauncey Booth, Jun., M. D., Assistant Physician. 

This Asylum can accommodate about 100 patients. Its 
fourth annual report, that for 1840, has recently appeared. 
During the year ending October 1st, 1840, 73 patients were 

* In the report, for 1840, of both this Asylum and that at Augusta. Maine, 
the name of this gentleman appears as assistant physician. 



85 i 

admitted and 61 discharged, including deaths. Of this number, 
33 were cured and 6 died. • Remaining in the Asylum, at the 
close of the year, 80. 

During the year ending October 1st, 1839, the number dis- 
charged was 38, cured 25. The whole number of admissions, 
from the time of opening to October 1st, 1840, is 239; the 
number of deaths 11. 



The 



recoveries, in 1840, of all cases disO 54 per cent 
charged, equalled 5 



of all cases discharged since? ea 

> 00. 6 

jement, 5 



" " " of 1<?SS I SS.2 

than one year's standing, 5 

" " " of more) 2g 5 

than one year's standing, 3 

u 

the commencement, 

of less , 
than one year's standing, 5 

" " . " ofmore ?28 2 " 

than one year's standing, 5 

Religious Worship. — Religious exercises are regularly 
performed, and have been found beneficial. 

Labour. — Those of the men patients whose condition will 
admit are employed "in the garden, on the farm, and about the 
premises." The women are engaged in needlework and do- 
mestic duties. 

Amusements. — The patients are furnished with the means 
of diversion and relaxation in walking, riding, fishing, reading, 
writing, drawing, painting, playing on the piano, and at the 
games of ball, quoits, cards, chess, backgammon, draughts, 
dominoes, battledoor and graces. 

MASSACHUSETTS STATE LUNATIC HOSPITAL AT WORCESTER. 

Samuel B. Woodward, M. B., Superintendent. 
George Chandler, M. D., Assistant Physician. 

The buildings of this institution are situated upon the sum- 
mit of an eminence commanding a beautiful view of the vil- 
lage of Worcester, and of the surrounding country. The 
8 



86 

principal edifice originally consisted of a centre building, 76 
by 40 feet, and four stories in height, and two wings, each 90 
feet long in front and 100 in the rear, 36 feet wide and three 
stories high. "The front of the centre building projects 22 
feet forward of the wings. The wings, being 36 feet wide, 
half their width, or 18 feet, joins upon the centre building; 
the other half falls in its rear." By this arrangement, light is 
freely admitted, and the means of thorough ventilation secured 
to the central galleries of the wings. This edifice furnished 
accommodations for 120 patients. Being found inadequate to 
the demands, two additional w r ings have been erected, one at 
either extremity of the original wings, touching the rear corners 
of the latter and receding at right angles from them. The 
squares thus left at the adjoining extremities of the old and 
the new wings is occupied by verandahs, of equal height 
with the wings, which are used as promenades by the patients 
of the several wards. The accommodations are thus rendered 
sufficient for from 230 to 240 patients. The first admission 
into this Asylum was on the 19th of January, 1S33. From 
that time to the 30th November, 1840, the number of admis- 
sions was 1196; of which 637 were men and 559 women. 
The number of discharges was 960, being 515 men and 445 
women. The results of their treatment may be learned from 
the following table: 





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Men, 


247 






54 






Women, 


259 






36 







Total, 506 175 185 90 4 960 



87 

The statistics for the year ending November 30th, 1840, are 
as follows: 





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Men, 


75 


68 


28 


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122 


Women, 


87 


87 


54 


9 






114 



Total, 162 155 82 15 29 29 236 

The average number in the Asylum during the year was 
229; the greatest number 245. Of the 155 cases discharged, 
70 were recent, or of a duration less than one year. Of these, 
64 recovered, 2 improved and 4 died. The remaining 85 were 
of longer duration than one year. Of these, 18 recovered, 26 
improved, 14 were harmless, and 15 were sent to places of 
security for want of room. 

Of all the recent cases which have been discharged 

from this Asylum, the average of recoveries is 87.25 p. ct. 

Of the same, discharged last year, " " 91.25 " 

Of all the old cases, " " 19.50 " 

Of those discharged last year, " '< 22.50 " 

Of all the cases, both recent and old, " " 52.00 " 

The same during last year, " " 53.00 " 

Of all the cases discharged, the average of deaths is 7.50 " 

The same during last year, " " 3.75 " 

445 patients were married, - 37.50 " 

751 do. including widowers and widows, were 

single, 62.50 " 

We are indebted, for the above statistics, to the intelligent 
and accomplished superintendent of the hospital under notice. 
His eighth report, from which these are extracted, is now in 
press, and will soon be published. 

The following statistics are condensed from his seventh 
annual report, made for the year ending Nov. 30th, 1839, at 
which time 1034 patients had been admitted into the hospital, 
and 805 discharged therefrom. 



88 

Species of Insanity. — Mania, 533; melancholia, 304; de- 
mentia, 146; idiots, 8; unclassified, 43. Total, 1034. 

Age of patients when admitted. 



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62 260 298 210 104 73 29 1026 

Civil State. — Single, 558; married, 374; widows, 63; wi- 
dowers, 39. 

Causes of Insanity. — Intemperance, — men, 151; women, 
20; total, 171: ill-health, 154; masturbation, 97; domestic 
afflictions, 107; religious, 78; loss of property, fear of po- 
verty, &c, 68; disappointed affection, 47; disappointed ambi- 
tion, 27; epilepsy, 34; puerperal, 24; injuries of the head, 
12; abuse of snuff and tobacco, 6. 

Arising from physical causes, 498; from moral causes, 324. 

Hereditary, or having insane ancestors or near kindred, 311. 

Periodical, 188; homicidal, 18; actual homicides, 13. 

Suicidal, or having a strong propensity to self-destruction, 
125; actual suicides, 5. 

Of 544 cases examined, 275 have dark complexions, hair 
and eyes, and 262 light complexions, hair and eyes. 

Of 165 periodical cases, 103 were caused by intemperance. 

Profession and Occupation. — Farmers, 124; labourers, 97; 
shoemakers, 42; seamen, 40; merchants, 33; carpenters, 27; 
manufacturers, 26; teachers, 23; blacksmiths, 13; printers, 
13; students, 11; tailors, 9; machinists, 8; clothiers, 6; pain- 
ters, 4; millers, 4; coopers, 4; paper-makers, 3; calico-prin- 
ters, 3; cabinet-makers, 3; clergymen, 4; sail-makers, 3; tan- 
ners, 3; bakers, 3; inn-keepers, 2; stevedores, 2; stone-cut- 
ters, 2; comb-makers, 3; musicians, 3; turners, 3; harness- 
makers, 3; pedlars, 4; physicians, 2; broom-makers, 2; cop- 
persmiths, 2; coachmen, 3; butchers, 2; currier, 1; brick- 
layers, 3; lawyer, 1; jewellers, 2; watchmen, 2; drovers, 2; 
news-collector, 1; rope-maker, 1; engineer, 1; hatter, 1; gar- 
dener, 1; idiots, 9; vagrants, 28. 



89 

Women unaccustomed to labour, 92; women accustomed to 
sedentary employments that are laborious, and to factory 
labour, 72; women accustomed to active employment, the 
wives and daughters of farmers, mechanics, &c, 12S. Many 
not classified. 

Religious Worship. — A chaplain is connected with the 
hospital, and services are regularly performed, twice every 
Sabbath, in a neat and commodious chapel erected for the 
purpose. 

The meetings are generally attended by from two-thirds to 
three-fourths of all the patients. The seventh report says 
"four-fifths of the patients who have been in the hospital 
during the last year, have attended — and most of them very 
regularly. The congregation varies from 175 to 200 and 
upwards. The experience of each day, strongly impresses 
us with the benefit of these religious services." 

Labour. — In no institution for the insane has manual labour 
been more extensively introduced as a part of the moral treat- 
ment, and in no one has its utility been more satisfactorily 
demonstrated. The men are employed in almost every de- 
partment of gardening and farming, and some of them work at 
shoemaking. The women are engaged in sewing, knitting, 
and domestic duties. 

The following list exhibits the number employed in 1839, 
together with their occupations. 

Men. 
Agriculture and horticulture, 40 

Shoemakers, 8 

In the kitchen, 5 

Washer, 1 

Woodsawyers, 16 

Mason-tenders, 3 



73 



Engaged in manual labour during the year, 179 

8* 



Women. 




Knitters, 


60 


Seamstresses, 


32 


Washers, 


4 


In the kitchen, 


4 


In the laundry, 


6 




106 




73 



90 

Amusements. — Walking, riding, the swing, draughts, and 
some other games, afford amusement and recreation. A library 
of nearly two hundred volumes belongs to the institution, 
and is much used by the patients. Tea-parties are given by 
the matron, weekly or semi-monthly, and a large dancing 
party assembles three or four times a year. Many of the men 
are permitted to walk where they please, generally going in 
companies of from five to twenty. In 1839, no less than 93 
were indulged abroad without an attendant. 

NEW YORK STATE ASYLUM FOR THE INSANE, AT UTICA. 

This Asylum is now in progress of erection. It is "to 
consist of four buildings, of three stories and a basement, the 
principal front to have the main building carried up an addi- 
tional story, to be located at right angles to each other, facing 
outwards, and to be connected, at the angles, by verandahs of 
open lattice-work, the whole enclosing an octagonal area." 
Each of the four buildings is to be 446 feet in length, by 48 
in width. That which forms the principal front is nearly 
completed. When finished, this institution will be by far the 
most extensive in the United States. The estimated cost of 
the buildings, is $431,636. 

MARYLAND HOSPITAL FOR THE INSANE, AT BALTIMORE. 

William Fisher, M. D., Medical Superintendent. 

This Asylum is situated about half a mile eastwardly from 
the city of Baltimore, upon an eminence which commands a 
beautiful view of the city and the surrounding country, inclu- 
ding the Patapsco river and Chesapeake Bay. 

Originally a general hospital, it was first exclusively devoted 
to the insane in 1839. It has been recently enlarged, making 
its accommodations sufficient for 150 patients. It has ten 
acres of land. 

The present number of patients is 56. The whole number 



91 

under care from January 1st, 1835, to January 1st, 1841, was 
393. 

Results of treatment. 



1 

^ P4 


CO j-; 

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CJ.S 


-6 

b 


ca O 

PS,S 


*3 
o 


75 


106 


34 


43 


393 



PS 
135 

A large majority of the cases were of more than one year's 
duration. 

The female department of this institution is under the im- 
mediate care of the "Sisters of Charity." 

Divine worship on the Sabbath has been introduced "with 
good effect." 

Labour. — Gardening, carpenter's work, and various domes- 
tic employments. 

Amusements. — Walking, riding; fishing, reading, and play- 
ing at quoits, chess, backgammon and draughts. 

WESTERN LUNATIC ASYLUM, AT STAUNTON, VA. 
Francis T. Stribling, M. J)., Superintendent. 

This is a state institution. The building, which possesses no 
inconsiderable architectural beauty, is situated upon an emi- 
nence, commanding a view of the surrounding country. The 
farm contains 65 acres. The Asylum went into operation July 
1st, 1828. From that time to July 1st, 1836, a period of eight 
years, there were 79 admissions and 13 cures. From July 1st, 
1836, to November 1st, 1839, the number admitted was 78; 
cured 34. Of the 78 admissions, but 30 were recent cases, or 
those of less than one year in duration. Of the recent cases 25 
were cured, which, exclusive of deaths and removals, is equi- 
valent to 83 per cent. 

Religious worship, at regular periods, has not been intro- 
duced. 

Labour. — The men patients are employed in tillage, fencing, 
cutting wood, excavating earth, &c. The work thus performed 
by them, in 1839, would have cost, if paid for at the current 



92 

prices of labour, about $600. The females knit, sew, and 
engage, to some extent, in domestic duties. 

Amusements. — A library of 300 volumes, horses and car- 
riage, a piano, violins, flutes, cards, balls, backgammon, draughts, 
graces and battledoor furnish means for amusement and recrea- 
tion. 

ASYLUM FOR THE INSANE AT WILLIAMSBURG, VA. 

Philip J. Barziza, Esq., Superintendent. 

This Asylum is also under the care of the state. It is one 
of the oldest institutions of the kind in the country, having 
been established before the revolution. When the British and 
American armies were near Yorktown, the buildings, having 
been temporarily vacated by the insane, were used as barracks 
and a hospital for the sick and wounded. We have seen no 
report and no statistics of this establishment, excepting the 
statement that, in 1838, the number of patients was about 80. 

OHIO LUNATIC ASYLUM AT COLUMBUS. 

William M. Awl, M. D., Superintendent. 
Samuel M. Smith, M. D., Assistant Physician. 

This Asylum was opened November 30th, 1838. It is con- 
structed on the plan of the original edifice of the Massachu- 
setts State Lunatic Hospital; it cost about $40,000. Thirty 
acres of land, which constitutes the farm, were purchased at 
the additional expense of 1980 dollars. 

The number of admissions, from the time of opening to 
November 13th, 1840, was 258. Of these, 140 were males 
and 118 females; 88 were recent cases, or those of less dura- 
tion than one year, and 170 were old cases. Of the patients, 
135 were single, 100 married, 17 widows and 6 widowers. 

During the same period 120 have been discharged, 69 of 
them being recent, and 51 old cases. The average number, 
during the last year, was 131, and 138 remained in the house 
at the expiration of that year. 

Species of Insanity. — Mania 170, melancholia 38, epileptic 



93 

mania 20, homicidial mania 4, moral insanity 11, dementia 12, 
idiocy or imbecility 3. Total, 258. 

Profession and occupation. — Labourers 24, millwrights 2, 
wagon-makers 2, miller 1, surveyor 1, mason 1, carpenters 8, 
students 3, tailors 4, merchants 2, cooper 1, collier 1, potter 1, 
engineer 1, farmers 47, blacksmiths 6, tobacconist 1, printers 
3, teachers 4, brewers 2, shoemakers 5, lawyers 3, saddlers 1, 
weaver 1, clerks 4, preachers 8, musicians 1, sea captain 1. 

Causes of Insanity. — Intemperance IS, domestic affliction 
10, puerperal 22, ill health 23, loss of friends 5, matrimonial 
perplexities 10, indulgence of temper 1, fright 3, political ex- 
citement 1, seduction 1, intense application 4, jealousy 2, dis- 
appointed love 10, epilepsy 17, excessive joy 1, injuries of the 
head 5, excessive use of snuflf 1, constitutional 15, disappoint- 
ment and mortification 16, masturbation 17, fear of want and 
loss of property 7, ill treatment from parents or guardians 6, 
religious 29, unknown 34. 

Religious worship. — Evening exercises of family worship 
are regularly performed, at which from 30 to 40 patients usually 
attend. A sermon is read on the Sabbath. 

Labour. — The men patients labour in "clearing up the pre- 
mises," grading and levelling the grounds, gardening, preparing 
fuel and taking care of the stock. The making and mending 
of the clothing of the indigent patients, and the washing and 
ironing for all the inmates of the house are mostly performed 
by the women. 

Amusements. — The patients walk in parties accompanied 
by an attendant; a tea-party is made weekly; dancing parties 
more rarely; books and stationary are distributed to such as 
wish, and some of the usual games, both within doors and 
without, are resorted to. "The 4th of July" is duly cele- 
brated, and the annual election, for the choice of state officers, 
is held with scrupulous regularity. 

KENTUCKY LUNATIC ASYLUM AT LEXINGTON. 

John Catherwood, Keeper. 
This institution has been in operation about sixteen years. 



94 

It has no resident physician. From the time of opening to the 

close of the year 1838, the number of admissions was 690, 

discharges 301, deaths, 297. Remaining January 1st, 1839, 

122, of whom 54 were men and 118 women. At the time of 

the prevalence of the Asiatic cholera, 43 of the patients died 

of that disease. 

The statistics of the first fourteen years of the operations of 

this Asylum are as follows: 

Per cent. Per cent. 

Admitted. Discharged. Died, of discharges, of deaths. 

Men 420 218 155 51.90 36.90 

Women, 207 58 83 28.01 40.09 



Women. 


Both sexes. 


16.36 


14.56 


21.42 


14.22 


1.81 


5.82 


28.57 


54.28 



Total, 627 276 238 44.10 37.95 

The number of cures is not stated in the reports. Of the 
627 patients included in the table, 118 were idiots and epilep- 
tics, all of whom have died. Deducting this number from the 
admissions and the deaths, the per centage of deaths will be 
23.57, or 1 in 4.24, and that of discharges 54.22, or 1 in 1.84. 

Men. 

P.ct. of deaths, 1838, of old cases 12.50 

" recent " 9.52 

P. ct. of discharges, of old " 10.41 

" recent " 71.42 

The reports give no information in regard to religious 
worship, labour and amusements. 

Active exertions are being made for the establishment of 
State Asylums for the insane in Connecticut, New Jersey and 
Pennsylvania; and during the present session of Congress, a 
bill has been passed for the foundation of one in the District 
of Columbia. 

SOUTH CAROLINA ASYLUM AT COLUMBIA. 

The state has appropriated 100,000 dollars to this institution. 
Nothing further than this can be said in regard to it, from want 
of data. 



95 



TENNESSEE ASYLUM AT NASHVILLE. 

James Overton, M. D., Superintendent. 

No information has been received from this institution since 
it went into operation. In 1838, the central building was 
completed and the wings in progress. 

CITY ASYLUMS. 

BOSTON LUNATIC HOSPITAL. 
John S, Butler, M. D., Superintendent. 

This institution is for the insane poor of the city of Boston, 
Massachusetts. It is situated in South Boston, on a spot 
which commands a prospect of the city and its beautiful har- 
bour. The edifice consists of a central building and wings, 
the whole being 160 feet in length. The expense of construc- 
tion was about 32,000 dollars. 

This Asylum was opened for patients December 11th, 1839, 
and in the first report, which appeared a few months since, the 
statistics are made out to July 1st, 1840. During the period 
included between these dates, 104 patients were admitted, of 
whom 57 were men, and 47 women. Ten of them were of 
less duration than one year, and 94 were of longer duration. 
Of the 10 recent cases, 4 were discharged, well, and 1 died. 
Of the 94 old cases, 10 were discharged stationary, 1 recovered, 
and 1 died. On the 1st of July, 1S40, 87 patients remained in 
the Asylum. 

A large proportion of the cases herein reported were of 
many years standing, the patients enjoying very good general 
health. 

Religious Worship.— Family worship has been introduced, 
and continued every evening, and religious services are gene- 
rally performed on the afternoon of the Sabbath. The average 
number of patients who attend is more than forty. 

Labour. — "Our male patients," says the report, "assist much 
in the out-door work of the hospital, though we have to regret 



96 



that we have so little opportunity of giving them constant and 
regular employment." 

Amusements. — The report says nothing upon this subject, 
except acknowledging the receipt of several donations of books 
and tracts, and remarking that they are received "with eager- 
ness" by the patients. 

NEW YORK PAUPER ASYLUM. 

This institution, founded by the city of New York, is situated 
upon BlackwelPs island. It is intended, when complete, to 
accommodate about 400 patients. 

That portion which was finished was opened for the recep- 
tion of patients about a year and a half since. On the 1st of 
February 1840, the number of patients was, men 100, women 
110 — total 210. Nearly all of these were removed from the 
almshouse at Bellevue. 

CORPORATE ASYLUMS. 



M'LEAN ASYLUM, CHARLESTOWN, MASSACHUSETTS. 
Luther V. Bell, M. D., Superintendent. 

This institution is connected with the Massachusetts General 
Hospital, and was opened more than twenty years since. It 
is one of the most complete, handsomely furnished and suc- 
cessful asylums in the country. It can accommodate about 120 
patients. We regret not to be able to present its full statistics. 
From the report for 1839 we glean the following: 

Remaining at the commencement of the year, . 93. 

Admitted during the year, 132. 

Total enjoying the benefits of the Asylum, in 1839, 225. 

Discharged during the year; . . . . 117. 

Remaining at the close of the year, . . . 108. 

Recovered, 90. 

Improved, 22. 

Stationary, 16. 

Died, 10. 



97 

The per cent, of deaths of all the inmates was, in 1835, 6.1; 
in 1S36, 5.5; in 1837,4.2; in 1838, 5.4: in 1839, 4.4. 

The number admitted, during sixteen successive years, was, 
of men 652, women 443 — total 1095. 

Religious Worship. — Daily devotional exercises are per- 
formed in the evening, and such of the patients as are suitable 
are permitted to attend the neighbouring churches on the Sab- 
bath. From one half to three-fourths of the patients attend 
the former, and of those who avail themselves of the latter, 
the average number is about 30. 

Labour. — The men work in the garden, on the farm, and 
in a large carpenter's shop. During the year 1836, 50 "worked 
in the carpenter's shop, six hours per day, and were employed 
151 days;" they made 7236 boxes, which sold for $907 06 cts. 
Several years since, a sewing society was established among the 
women, which is, undoubtedly, still continued. The avails of 
their labour, during the first eighteen months, was $112 96 cts. 

Amusements. — The usual games are introduced; dancing 
and tea-parties are occasionally made, and a library of a few 
hundred volumes is devoted to the use of the patients. 



CONNECTICUT RETREAT FOR THE INSANE. 
Jlmariah Brigham, M. Z>., Superintendent. 

This Asylum is pleasantly situated, about one mile from the 
city of Hartford. It is upon a gentle elevation of ground, and 
commands a fine prospect of the cultivated country by which 
it is surrounded. It was opened in April 1824, with accom- 
modations for 60 patients. In 1831, it was sufficiently enlarged 
to accommodate 100. 

This institution has enjoyed a high reputation, which, we 
doubt not, will be fully maintained by the present accomplished 
superintendent, who has but recently entered upon his duties. 

From the sixteenth report, not long since published, we 
extract the following table, exhibiting the annual number of 
9 



98 



admissions, recoveries and deaths, from the opening of the 
Retreat. 



Recent cases Recent cases 



Years. 


Admitted. 


Cured. 


admitted. 


cured. 


Deal 


1824-5 


44 


10 


12 


6 


1 


1825-6 


33 


16 


16 


13 


1 


1826-7 


37 


24 


23 


22 





1827-8 


40 


27 


25 


22 


4 


1828-9 


42 


26 


20 


19 


2 


1829-30 


51 


28 


25 


23 





1830-1 


53 


32 


25 


23 


1 


1831-2 


80 


46 


42 


38 


6 


1832-3 


68 


37 


30 


28 


4 


1833-4 


72 


43 


33 


32 


3 


1834-5 


72 


36 


36 


28 


6 


1835-6 


73 


42 


35 


29 


6 


1836-7 


91 


55 


60 


48 


6 


1837-8 


67 


42 


41 


35 


10 


1838-9 


94 


49 


61 


45 


8 


1839 


84 


50 


53 


40 


2 






___ 


_ 


____ 


_ 



Total, 1001 563 537 451 60 

Religious Worship. — At this Asylum they have prayers 
every evening, and religious service on the Sabbath, conducted 
by a regular chaplain. 

Labour and Amusements. — The reports before us contain 
nothing upon these subjects. 

BLOOMINGDALE ASYLUM. 
William Wilson, M.D., Resident Physician. 

The Bloomingdale Asylum is one of the finest institutions 
of the kind in the United States. It is beautifully situated, a 
few miles from New York city, and has extensive and well 
cultivated grounds. It commenced operations in 1821. 

From the reports of 1S31, 1832, 1834, 1835 and 183S, we 
have obtained the following statistics. During those five years, 
there were 631 patients admitted, of whom 405 were men and 
266 women. The number of recent cases was, of men, 213; 
women, 111; total, 324: that of old cases, men, 192; women, 
115; total, 307. 



99 

The results of treatment were as follows: 





tj 








£ 


o a> 

■♦-» CO 










S 






CO . 


<u 2 








<D 


""" T3 


> 




>-2 


>•$ 


T3 






> 


pC £ 


o 




o-a 


O m 


a> 






O 

o 

0) 


P O 


s 


s 






O 


c3 

o 

H 


Recent cases, 


260 


10 


rr 


18 


21 




3 


329 


Old cases, 


42 


4 


66 


64 


74 


37 


9 


296 



Total, 302 14 83 82 95 37 12 625 

During the year 1839, the whole number in the asylum was, 
men 154, women 97, total 251. The number admitted was, 
men 69, women 44, total 133. Of the admissions, the number 
of cases of less duration than one year was, men 44, women 
20, total 64; that of cases of longer duration than one year, 
men 25, women 24, total 49. Remaining, Jan. 1st, 1840, 
men 74, women 52, total 126. 

Recent cases. 

Recovered. Improved. Stationary. Died. Total. 
Men, 37 2 4 43 

Women, 15 2 2 19 



Total, 52 4 6 62 

Chronic cases. 

Recovered. Improved. Stationary. Died. Total. 

Men, 13 13 6 5 37 

Women, 3 15 5 3 26 

Total, 16 28 11 8 63 

Whole number discharged, 125. 

Species of Insanity. — Of the 126 patients remaining at the 
close of the year in question, there were suffering under mania 
39, monomania 32, dementia 51, idiocy 4. 

Profession and Occupation. — Merchants 14, farmers 11, 
seamen 9, clerks 8, servants 6, milliners and dress-makers 5, 
lawyers 3, physicians 3, cabinet-makers 3, tailors 2, watch- 
makers 2, students 2, carpenters 2, teachers 2, saddler 1, cur- 
rier 1, inn-keeper 1, shoemaker 1, butcher 1, blacksmith 1, no 
occupation, chiefly females, 48. 



100 

Causes of Insanity. — Hereditary 20, intemperance 12, do- 
mestic trouble 10, pecuniary embarrassments 9, puerperal 8, 
fevers and other diseases 8, disappointed affection 6, mental 
exertion 6, religious excitement 5, congenital 4, cerebral disease 
4, uterine disorders 3, masturbation 3, constitutional 3, injuries 
of the head 2, isolation 1, mortified pride 1, remorse 1, anti- 
masonic excitement 1, sudden wealth 1, unknown 20. 

Religious Worship. — There is one religious service each 
Sabbath, at which such of the patients as are suitable, attend. 

Labour and Amusements. — The reports before us are silent 
upon these subjects, but from the character and reputation of 
the institution, we presume it is not "behind the age" in re- 
gard to the introduction of these among the patients. 

PENNSYLVANIA HOSPITAL. 

A department of this extensive and useful institution, the 
oldest of the kind in the United States, has always been de- 
voted to the insane. The following table exhibits the number 
of admissions, and the results of treatment, from February 
11th, 1752, to April 28th, 1832, a period of more than eighty 
years. 





0> 

'i 

< 


0) 

3 

o 


> 




T3 
O 


P 


S 

(L) 


Men, 


2509 


905 


488 


499 


188 


359 


66 


Women, 


1209 


384 


292 

780 


264 
763 


42 
230 


171 

530 


60 


Total, 


3718 


1289 


126 



From April 28th, 1832, to April 28th, 1S40, the number 
admitted was 584; cured 191; died 72. 

Previous to the year 1823, the cases of mania a potu were 
included with those of insanity. Since that year they are not 
included. 

Of 394 consecutive admissions, the ages of the patients was 
as follows: — 



101 



g©» c^co co tj< rj< in vn o o r~ i> oo 
o o oo o o o o o o o o o o 

25 59 66 77 44 45 30 16 14 10 3 3 2 

Civil Slate. — Of 284 men, 170 were single, 97 married, and 
17 widowers; and of 202 women, 70 were single, 97 married, 
and 35 widows. 

The patients of this institution, of whom there are about 
one hundred, are now being removed to the new Asylum, 
west of the Schuylkill. 

ASYLUM AT FRANKFORD, PENNSYLVANIA. 

John C. Redmond, Superintendent. 

Charles Evans, M. D., Attending Physician. 

Pliny Earle, M. D., Resident Physician. 

This institution, generally called, in the reports, "The Asy- 
lum for the Relief of Persons deprived of the use of their 
Reason," is pleasantly situated, about six miles northerly from 
the city of Philadelphia. The principal edifice consists of a 
central building and wings, and, at the extremity of the latter, 
other buildings, called "lodges," intended for such patients as 
may be so noisy as to disturb the others. The front formed 
by these several portions is 322 feet 8 inches in length. The 
farm contains sixty-one acres, which is divided into airing 
courts, and garden, tillage and woodland. The airing courts 
and the grounds in front of the building are well shaded with 
large and beautiful trees. 

This Asylum was opened in Fifth-month, (May,) 1817, 
and, for many years, was restricted exclusively to members of 
the Society of Friends. In 1834, however, it was opened to 
others, who still continue to be admitted. 

The number of admissions, from the time of opening to the 
close of the year 1838, a period of nearly 22 years, was 634. 
Of these, 331 were men, and 303 women. 

Civil State. — There were, single, 326; married, 234; wi- 
dowers, 17; widows, 57. 
9* 



102 

Ages at the time of admission. 



Si 


d 

I" 


3 


o 


d 


R 


8 


d 

C5 


o 
o 


Is. 


o 


o 


o 


o 


o 


o 


o 


o ■- 
















n8 


£§ 


o 


o 
9 


o 


o 


£ 


i 


o 



o 
H 

28 187 141 126 83 48 15 5 1 634 



Of the 634 patients, 507 were never readmitted. The fol- 
lowing table exhibits the results of their treatment: 



Duration. 


<U 


u 

o 


-C o 


-a 

> 

o 


O 


bo 

'5 
'c3 






I 

< 






si 

O-, 

S 


03 

w 


S 


-6 
Q 


Less than 1 year, 


261 


152 


26 


27 


18 


4 


34 


From 1 to 2 years, 


57 


18 


8 


8 


9 


7 


7 


u 2 " 3 " 


36 


17 


3 


3 


4 


5 


4 


e« 3 n 5 a 


45 


14 


7 


6 


9 


3 


6 


" 5 " 10 " 


47 


13 


7 


3 


8 


11 


5 


Over 10 


61 





7 


5 


22 


13 


14 



Total, 507 214 52 52 70 43 70 

During the year ending 1st of 3d month, (March,) 1840, the 
number of admissions was 54, that of discharges, including 
deaths, 60. Of the latter, 25 were restored, 5 much improved, 
9 improved, 17 stationary, and 4 died. 

Religious Worship. — Those patients whose condition will 
admit, assemble on Sabbath afternoons to hear a portion of 
the Scriptures. Some of them attend meeting in the village 
of Frankford. 

Labour. — During the warm season, many of the patients are 
employed in gardening and farming. In winter, they work in 
two shops, one devoted to basket-making, the other to carpen- 
try. They keep the reservoirs in the Asylum supplied with 
water, throughout the year. It is driven up by a forcing 
pump, operated by a crank. 

Amusements. — A grove of about twenty acres, at one ex- 
tremity of which an enclosure of two acres contains several 
deer, and, at the other, a summer-house is erected amid 



103 

romantic scenery, forms a pleasant place for rambling in sum- 
mer. Horses and a carriage are devoted to the use of the 
patients, and the means are furnished for many of the games 
mentioned in the notices of other Asylums. Tea-parties are 
given occasionally, and lectures upon Natural Philosophy and 
Chemistry are delivered, weekly, during the winter. But the 
sources of diversion most resorted to are, 1st, a circular rail- 
way upon the lawn in front of the house, in a small car upon 
which two persons may drive themselves, with great rapidity, 
by means of a crank; and, 2d, a library. A small building, at 
the extremity of the garden, opposite the house, is devoted to 
this purpose. Externally, it is surrounded with a corridor, 
the pillars of which are overgrown with honeysuckle. With- 
in, it is carpeted, and otherwise well furnished; upon the walls 
are framed engravings; two series of shelves are supplied with 
about 300 volumes of useful books; the whole of one side of the 
room is occupied by a cabinet of minerals, shells, corals and 
stuffed birds and quadrupeds, while lemon and orange trees, 
with a variety of flowers, give a delightful fragrance to the 
air. This retreat is much resorted to by the patients, — the 
women having the use of it during the forenoon, and the men 
in the afternoon. 



PENNSYLVANIA HOSPITAL FOR THE INSANE. 

Thomas S. Kirkbride, M. D., Superintendent. 

This Asylum is situated about two miles westwardly from 
the city of Philadelphia. It is a splendid establishment, no 
expense that would contribute to the suitable accommodation 
of the patients having been spared in its erection. A large 
farm is connected with it, about forty-two acres of which is 
surrounded by a high stone wall. 

It is but about six weeks since the Asylum was opened. 
Nearly fifty of the patients formerly at the Pennsylvania Hos- 
pital, in the city of Philadelphia, have been removed to this 
place, and the remainder will soon be transferred. The ac- 
commodations, when complete, will be sufficient for more than 



104 

200. Under the care of its intelligent and assiduous Superin- 
tendent, this will, undoubtedly, become one of the best insti- 
tutions in the country. 

PRIVATE ASYLUMS. 

HUDSON LUNATIC HOSPITAL. 



This institution was established by Drs. S. and G. H. White, 
and is still continued under their supervision. The following 
are the statistics for 1838 and 1840. 

The whole number under care in 1838 was 98; of which 30 
were recent cases, 65 chronic, and 3 intemperate. The whole 
number in 1840 was 84; of which 25 were recent, 54 chronic, 
and 5 intemperate. 

Results of treatment in the cases discharged. 









Recent 


cases. 










u 

o 






T3 
> 

o 

s 


Stationary. 
Died. 


1838, 




15 


5 




5 


1 1 


1840, 




14 






2 


2 




Chronic cases 








Intemperate. 




T3 
03 

i> 
o 
o 

0) 


3 O 


T3 

> 
O 

n< 
S 


>> 

S-, 
C3 

ii 


s 


Reformed. 
Un reformed. 


1838, 


9 


21 


15 


10 


4 


2 1 


1840, 


7 


10 


5 


2 


3 





Remaining, January 1st, 1839, 43; January 1st, 1841, 36. 

The whole number admitted from the opening of the insti- 
tution to January 1st, 1841, is 503. 

Family worship is continued daily, and with beneficial 
effects upon the patients. We have no information in regard 
to labour and amusements. 



105 

There is a private Asylum at Pepperell, Massachusetts, 
under the care of Dr. Cutter, and another at Cambridgeport, 
in the same state, established by Dr. Chaplin, and continued, 
since his decease, under the superintendence of his widow. 

ASYLUM AT MILLEDGEVILLE, GEORGIA. 

We know not under which of the above classes to place this 
institution; nor can we say anything in regard to its extent, 
organization or success. 



OF THE 

CAUSES, DURATION, TERMINATION AND MORAL 
TREATMENT OF INSANITY. 



The object in this essay is not to enter into an elaborate dis- 
cussion of the subject of mental derangement, but to adduce 
propositions heretofore stated in regard to that disease, and 
subject them, as far as possible, to the test of statistics, with a 
view to the demonstration of their truth or falsity. Besides 
this, we wish to illustrate the modern mode of moral treat- 
ment, by examples adduced from various asylums, and to de- 
monstrate the utility of that treatment, in its results, combined 
with other remedial agents, upon the patients subjected to its 
influence. 

Causes of Insanity. — These have, with evident propriety, 
been divided into, first, those which predispose to the disease, 
and secondly, those which excite it. 

1. Predisposing Causes. — Under this head we shall consider 
the constitution, temperament and complexion, age, sex, civil 
state and education. 

a The state of the constitution is undoubtedly, in many 
instances, a most powerfully predisposing cause of some of the 
forms of insanity. A peculiar organization of the cerebro- 
spinal system, and, according to Dr. Rush, of the blood-vessels 
also, an organization molecular in its nature', and consequently, 
particularly in relation to the nervous system, inappreciable 
by the senses, favours the encroachment of the disease. This 
condition may be hereditary, or may arise, de novo, in a family 



108 

entirely free from the maniacal taint. The progress recently 
made and still making in transcendental anatomy, together 
with the great improvements in microscopes, may encourage 
us in the belief that we shall eventually be enabled to ascertain 
the nature of this, if we may use the term, congenital lesion. 
We have abundant proofs that this cause is hereditary. At 
the Pennsylvania Hospital, Philadelphia, application was made 
for the simultaneous admission of three lunatics, members of 
the same family. One of the patients of the Retreat for the 
Insane in Hartford, Connecticut, was the eleventh individual 
of his family who had suffered under an attack of mania. M. 
Esquirol says that hereditary transmission is more frequent 
among the opulent than in other classes of society. Such 
children of maniacs as are born before their parents become 
deranged, are less liable to inherit the predisposition than those 
who are born subsequently. Children whose parents are both 
maniacal, are more liable to the disease than those of whom 
but one parent is so. According to Dr. Barton, the children 
of persons in the decline of life are less subject to insanity than 
those whose parents are young. 

The following table exhibits the proportion of patients, of 
some of the asylums, in whom the disease was hereditary. 

Asylums. No. of patients. No. hereditary. 



Charenton, 


1264 


337 


Richmond, Dublin, 


608 


13 


Under care of W. C. Ellis, 


13S0 


214 


Massachusetts State, 


1034 


311 


Ohio State, 


311 


15 



With regard to those under the care of Sir W. C. Ellis, 
that author remarks, "If we had more complete information, I 
have no doubt that the insanity would be found to have been 
hereditary in a much greater number." According to Ellis, 
"relatives by blood intermarrying with each other, have a 
progeny prone to insanity. Why it is so, I do not presume 
to give an opinion; but of the fact I have no doubt, not only 
from what has come within my own knowledge, but from its 



109 

having been particularly noticed by Dr. Spurzheim and others, 
who have paid great attention to the subject: it cannot be too 
generally known and guarded against." 

In many instances the disease manifests itself in several 
individuals of the same family at nearly the same age. Dr. 
Rush says that among the patients in the Pennsylvania Hos- 
pital, were a father and two sons, all of whom became deranged 
between the ages of 60 and 70 years. Two sons of a merchant 
in Switzerland died insane at the age of 19 years. Dr. Prichard 
mentions three other cases of a similar kind. M. Esquirol be- 
lieves that fright in the mother, during pregnancy, may excite 
a strong predisposition to insanity in the infant with which she 
is pregnant. Although there are probably but few who will 
concur with him in the opinion, it is a point which, as being 
thus spoken of by an individual of so extensive observation, at 
least merits attention. 

Discovered in early life, the constitutional predisposition, 
whether inherent or not, may be very much checked in its 
progress, if not entirely eradicated, by proper treatment. 

b Temperament and Complexion.— People of choleric and 
nervous temperaments are said to be more liable to the inva- 
sion of insanity than others; a predisposition which is greatly 
fostered in those who give a loose rein to their passions. 
Haslam, Rush and some others, believe dark-coloured hair to 
be indicative of a maniacal predisposition. In Bethlehem 
Hospital, London, according to the former gentleman, of 265 
patients, 205 had hair of this colour; and in the Pennsylvania 
Hospital, in 1S12, according to the latter, of 79 insane inmates, 
73 were of a similar description. Of 544 patients examined 
at the Massachusetts State Hospital, 275 had dark complexions, 
hair and eyes, and 269 light complexions, hair and eyes. The 
per centage with regard to Bethlehem Hospital is somewhat 
remarkable when we take into consideration the large propor- 
tion of people with light-coloured hair in England. It would 
not be remarkable in France. Dr. Prichard can trace a pre- 
disposition to no particular complexion. 

c Jlge. — The middle period of life is by far the most prolific 
in cases of mental alienation; and this from the evident reason 
10 



110 

that both males and females are more exposed, during that 
portion of their existence, to the various exciting causes, than 
they are in either early or advanced life. Attacks in very 
early life are extremely rare. Dr. Rush mentions four cases 
of the kind which came within his knowledge; and in St. 
Luke's Hospital, England, there was an insane child of but 
two years of age. Dolaeus, Greding and Rush mention in- 
stances of attacks in very advanced life; the last mentioned 
having observed one which occurred in a person more than 
SO years of age. 

The British and the European continental writers upon the 
subject, generally, if not invariably, assert that more persons 
are attacked between the ages of 30 and 40 years, than during 
any other interval of ten years in life. This appears to be 
sustained by the following table of M. Georget and Dr. Bur- 
rows. 



<" — : . . • • 

'£ S o o o © o 



Hospitals. c, "3 t3 ** is t3 -a 

°S« G B 5 S r» 

. d d ci d rtei >'c 

French & English, 4409 356 106 1416 361 461 174 35 

French, 2507 140 465 572 521 350 265 189 6 



Total, 6916 496 571 19SS 882 811 439 224 

The results exhibited by the following table, however, tend 
to disprove the truth of the assertion. 



_ o 


g 


o 


o 


© 
1=> 


© 


s 


o 


o o 


o 


o 


o 


o 


o 


o 


o 


feiO 


a 


o 

BO 


© 


© 


© 
to 


R 


© 

X 



Bicetre, from 1784 7 3g0 236 g 53 H93 

to 1793, S 

Salpetriere, from 5 3Q6 25g 144 2Q5 n5 Q6 23 nis 

1811 to 1814. S 

Esquirol's private, 150 78 30 46 15 5 3 327 

Total, 65 785 717 410 381 183 71 26 2638 



Ill 



Whether it be true or not in regard to Europe, we believe 
it to be untrue if applied to the United States. This belief is 
induced by the statistics of the table which follows. 





SB 


© 

C5 


o" 


s 


© 
© 


* 


© 

00 


© 

C5 


© 




Asylums. 


Time. g o 


O 


O 


o 


o 


o 


o 


o 


o 


03 
O 




8 


O 


o 


© 


© 


o 


Q 


© 




rH 


CO 


t5" 


vO 


© 


F- 


DC 


OS 


Mass. State, 


1833 to 1839, 62 


260 


298 


210 


104 


73 


29 






1036 


Virginia, at Staunton, 


lyear, 8 


25 


33 


24 


10 


3 


1 






104 


Ohio State, 


1839 & 1840, 11 


108 


66 


41 


26 


5 


1 






258 


1 Kentucky State, 


1 vear, 


8 


39 


24 


10 


5 


2 


1 






89 


jM'Lean, Mass., 


15 years, 


70 


352 


264 


191 


91 


38 


9 






1015 


|Retreat, Conn. 


7 years, 


19 


107 


73 


54 


20 


6 


4 






286 


iBloomingdale, N. Y., 


in 1839, 


3 


30 


37 


22 


19 


7 


1 






126 


Frankford, Pa., 


1816 to 1838/ 28 


187 


141 


126 


83 


48 


15 


5 


1 


634 


Pennsylvania, 


1832, i 3 


32 


29 


27 


33 


12 


12 


2 




138 


Total, 


212 


1140 


965 


705 


391 


194 


73 


7 


1 


4484 



By this it appears that a considerably larger number become 
insane in the United States between the ages of 20 and 30, than 
during any other period of equal length. Bi.it the evidence of 
this table is, to a certain extent, deceptive; the ages reckoned 
are, in most of the cases, those of the patients at the time they 
ivere admitted into the several hospitals, and, in many others, 
at a time when they had been in the hospitals several years. 
Now, could these be so corrected as to state the age at the time 
of the attack, the table would be of more value, and we should 
have more striking evidence of the fact in question. But there 
was no means by which that correction could in all instances 
be made. Wherever the means did exist, advantage was 
taken of it, and the result is as follows: 



Hospitals. 


s s 

jS 2 


1 

© 


© 
© 

CO 


© 

© 


© 
© 

! 
© 


© 

CO 


© 

00 


*e3 
o 


Retreat, Connecticut, 


2 11 


36 


22 


22 


11 


2 


_ 


104 


M'Lean, Massachusetts, 


1 7 


30 


21 


11 


8 


2 


1 


80 


Massachusetts State, 


- 35 


127 


99 


70 


33 


15 


5 


384 


Frankford, Pennsylvania, 


4 9 


32 


16 


9 


7 


5 


2 


80 



Totals 



62 225 158 112 59 24 8 648 



112 



The change effected by this correction is remarkably exem- 
plified in the cases at the Frankford Asylum. As they were 
before alteration, the proportion of those between 20 and 30 
years to those between 30 and 40 was as 9 to 7; whereas, after 
being corrected, it is as 2 to 1. In the total numbers previous 
to correction, those between the ages of 20 and 30 are to those 
between 30 and 40 nearly as 11 to 9; while in the same, after 
correction, the ratio is as 11 to 7. 

d Sex. — It was asserted by ancient writers that, in their 
time, more males than females suffered under the various forms 
of mental derangement. The reverse appears to be true in 
modern Europe. Pinel estimates that in France, in 1802, the 
ratio of insane females to males was as 2 to 1. In England it 
is far less. At Bethlehem Hospital, agreeably to Dr. Haslam, 
of 8874 patients, 4042 were males, and 4832 females. At St. 
Luke's there were one-third more females than males. M. 
Esquirol, from statistics derived from several countries, con- 
cludes that the proportion "does not, in fact, greatly exceed 
the difference which exists between the sexes in the ordinary* 
state of population." Judging of the proportionate number of 
the sexes insane in the United States from those confined in 
the several hospitals, we must conclude that there are more 
men than women. See the following table. 



Asylums. 


Time. 


Men. 


Women. 


Total. 


Maine State, 


21 months, 1840, 


22 


8 


30 


Massachusetts State, 


1833 to 1840, 


637 


559 


1196 


Va. State, Staunton, 


in 1839, 


56 


48 


104 


Ohio State, 


1839 and 1840, 


140 


118 


258 


Kentucky State, 


1824 to 1838, 


420 


207 


627 


M'Lean, Massachusetts, 


in 16 years, 


652 


443 


1095 


Retreat, Connecticut, 


cc 9 u 


183 


199 


382 


Bloomingdale, N. Y., 




607 


302 


909 


Pennsylvania Hospital, 


1752 to 1832, 


2509 


1209 


3718 


Frankford, Pa., 


1817 to 1838, 


331 


303 


634 



Total, 5557 3396 8953 



This makes the number of men to that of women as 5 is to 
3. It can hardly be believed that there would be so great a 



113 

predominance of men in the asylums, if there were not, in 
reality, a greater number of them in the country who are 
insane. There are reasons, however, for inducing the belief 
that the disproportion between the two sexes is not so great as 
is represented by this table. Yet it is thought that the evi- 
dence is sufficiently conclusive in warranting the assertion 
that, in the United States, there are more men than women 
suffering under mental alienation. Should future observations 
demonstrate the truth of this proposition in regard to our 
country, and its converse in regard to continental Europe, to 
what shall be attributed this difference in the two countries? 
We believe the causes of that difference will be chiefly found 
in the difference of condition, of the men, with regard to pe- 
cuniary affairs, and that of women in society. But it would 
be untimely to enter into a discussion of this subject before 
the proposition in question be satisfactorily demonstrated. 

Dr. Rush believed that the number of insane women is 
greater than that of insane men, from the fact that the former 
are exposed to several exciting causes from which the latter 
are exempt; such are the derangements of the catamenia, 
utero-gestation, parturition, and the peculiar situation of their 
sex in society. But, on the other hand, it will be found that a 
very large proportion of male lunatics are brought to that un- 
happy situation by causes from the influence of which females 
are either partially or wholly removed. Among these are in- 
temperance and pecuniary embarrassments. 

e Civil State. — Georget believes celibacy to be a predis- 
posing cause of insanity. S. Tuke, also, considers it as among 
those which are the most prominent of this class. There is 
much plausibility in this opinion, even admitting it not to have 
been founded upon direct observation. Unmarried people are 
more liable than others to some of the exciting causes of the 
malady; and unmarried females, particularly, are more subject 
than those who are married to other nervous affections. Yet, 
admitting that there are a greater number of single than of 
married persons among the insane, it is still difficult to ascer- 
tain positively whether this is to be ascribed solely to the 
influence of celibacy. M. Desportes states, that of 1668 insane 
10* 



114 



females, 980 were single, 291 widows, and 397 married; and 
of 764 insane males, 492 were single, 59 widowers, and 201 
married. 

The following table, compiled from the reports of several 
of the hospitals in the United States, goes to confirm the 
opinion of M. Georget. 







MEN. 


WOMEN. 


Ul 


S 


3 


H 


Ul 


§ 


*£ 


H 


ASYLUMS. 


TIME. 


3 


P5 


ol 




=3 

aq 


&3 


oL 


U 










o 


















CO 

a- 


< 

fa 






CD 

a- 


3 

CD 




Maine State, 


2£ months 1840, 


15 


7 




22 


4 


3 


1 


8 


Massachusetts State, 


1833 to 1835, 


135 


68 


19 


222 


83 


50 


24 


157 


Va. State, Staunton, 


in 1839, 


38 


11 


3 


52 


21 


18 


6 


45 


Kentucky State, 


in 1838, 


65 


13 


8 


86 


47 


21 


22 


90 


M'Lean, Mass., 


1 year, 


27 


18 


3 


48 


16 


12 


4 


32 


Retreat, Connecticut, 




119 


80 


4 


203 


80 


86 


12 


178 


Bloomingdale, N. Y., 


in 1839, 


36 


29 


2 


67 


15 


24 


7 


46 


Frankford, Pa., 


1 year, 


27 


18 


3 


48 


22 


6 


5 


33 


Penn. Hospital, 




170 


97 


17 


284 


70 


97 


35 


202 


Total, 




632 


341 


59 1032 


358 


317 


116 


791 



Of the 1823 cases herein reported, 990 had never been mar- 
ried, 658 were married, and 175 were widowed. The pro- 
portion, in men, of the single to the married is nearly as 2 to 1, 
while that in women is as 1.12 to 1; and that in both sexes is 
as 1.5 to 1. The number of widows is very nearly twice as 
great as that of widowers, a result which might have been an- 
ticipated, from a knowledge of the greater susceptibility of the 
female mind to the influence of grief. 



115 



In the following table, no distinction is made between the 
sexes, excepting in the case of widowers and widows. 



ASYLUMS. 


TIME. 


5" 
5T 


3 

cd° 


o 

CD 

w 


3j 

o 

02 


t-3 
6" 


Massachusetts State, 


1833 to 1839, 


558 


374 


39 


63 


1034 


Ohio State, 


1839 & 1840, 


135 


100 


6 


17 


258 


Frankford, Pa., 


1817 to 1838, 


326 


234 


17 


57 


634 


.M'Lean, Mass., 




556 


532 


3 


4 


1095 


Total, 




1575 


1240 


65 


141 


3021 



The statistics of the Massachusetts State, the Frankford, 
and the M'Lean Asylums which are in the former table, are 
included in those of the same institutions in the latter table. 
In regard to the cases of the M'Lean Asylum, it is believed 
that, with the exception of one year, the widowers and wi- 
dows are included with the married. Notwithstanding this, 
the proportion of the single to the married is as 3 to 2, or 
as 1.5 to 1, a result almost precisely corresponding with that 
of the former table : its similar correspondence is also perceived 
in the ratio of widowers to widows. 

Finally, rejecting, in the former table, those numbers which 
are included in both, we have a total of 4304 cases, of which 
2255 were married, 1726 single, 99 widowers, and 224 wi- 
dows. The proportion of the single to the married is as 1.283 
is to 1, and that of widowers to widows as 1 to 2.26. 

f Education. — An injudicious education is believed by Dr. 
Prichard to predispose to mental derangement. "It may be 
erroneous," says he, "in two ways:" (we abridge from the 
author) 1st, by too lenient a government, allowing the passions 
to act uncontrolled and unsubdued, and never exercising that 
wholesome moral restraint which seems necessary to promote 
the happiness, as well as to. conduce to the integrity of the 
health of the individual; and 2d, by over exertion of the men- 
tal faculties, and a neglect of the cultivation of the physical 
powers and the moral feelings. 



116 

It is well that so prominent an individual as Dr. Prichard 
has raised his voice against the great error in modern educa- 
tion included under the second head. It is an evil which, in 
our country, exists to too great an extent, and calls loudly 
for reform — complete, unsparing, radical reform. And inas- 
much as it involves the health and happiness of so great a por- 
tion of our countrymen, may we not hope that the subject will 
obtain an increased attention among those who have the power 
to effect a change? 

Sir W. C. Ellis, also, alludes to the errors of education as 
contributing to increase the number of lunatics, and deprecates 
the modern institutions termed "infant schools," as being pro- 
ductive of injury, by requiring a mental effort too severe for 
the brain to bear, with impunity, during the early years of 
childhood. 

Apoplexy, epilepsy and paralysis are considered among the 
predisposing causes of insanity, inasmuch as they induce a pe- 
culiar state of the encephalon, upon which this malady may 
easily supervene; but the most potent of all causes of this kind 
is a previous attack of mania. 

2. Exciting Causes. — The exciting causes of insanity, like 
those which predispose to the disease, are divided into two 
classes, physical and moral. The number of causes in either 
of these classes is so great, and some of them, at the same 
time, of so little comparative importance, that it would be of 
little utility to enter into a special discussion of each. 

a Physical Causes. — Intemperance, the hydra of modern 
days, appears to be the most prolific of mental disease of all 
the causes belonging to this class. Attesting to the truth of 
this, we have the authority of Esquirol, in regard to France, 
of Ellis and Prichard, in regard to Great Britain, and of Rush, 
Woodward, and others, in regard to the United States. Du- 
ring the residence of Dr. Waters in the Pennsylvania Hospi- 
tal, one-third of the cases of insanity admitted arose from 
intemperance. 

The following statistics of four Asylums will exhibit the 
influence of intoxicating liquors, in the production of the 
disease: 



117 





Produced 


by 




Asylums. Admissions. 


intemperance. 


Per cent. 


Turin, 1066 


76 




7.12 + 


Charenton, 1557 


134 




S.60 + 


Massachusetts State, 1034 


171 




16.53 + 


Ohio State, 258 


IS 




6.97 + 



At Charenton, besides the 134 attributed solely to intoxica- 
tion, there are 146 stated to have been produced by "excesses 
of all kinds," which may be supposed to include intemperance 
in drinking. 

Masturbation. — Nearly all recent writers upon insanity, 
unite in acknowledging that this is a much more prolific 
source of the disease than has heretofore been supposed. They 
also coincide in the opinion, that the cases produced by it are 
among the most incurable, and a great proportion of them sink 
into imbecility, fatuity or dementia. Among the best autho- 
rities upon this subject are, Sir W. C. Ellis on Insanity, 
Esquirol on Mental Diseases, the Reports of the Massachusetts 
State Lunatic Hospital, and two treatises, the one entitled 
"Hints for the Young, in relation to the Health of Body and 
Mind," and the other, "An hour's Conference With Fathers 
and Sons, in relation to a common and fatal Indulgence of 
Youth." These treatises, although published anonymously, 
were written by Physicians who have had extensive experi- 
ence in the treatment of the insane. 

Climate, season, and profession, are included, by some wri- 
ters, among the predisposing causes of insanity. We prefer, 
for what we think to be obvious reasons, to place them with 
the exciting causes. 

Climate. — It will be found that the number of lunatics is 
greatest in those countries which, being situated in the tempe- 
rate zone, are subject to the extremes of heat and cold^and to 
sudden vicissitudes in the weather. 

Season. — The proposition whether any one of the seasons 
predisposes, in a greater degree than either of the others, to 
insanity, is not yet fully demonstrated. 



118 

The following table exhibits the number of admissions to 
three large Asylums, in each of the respective seasons: 



Asylums. 


Time. 


Winter. 


Spring-. 


Summer. 


Autumn. 


Salpetriere, 


1806— 1S14 


531 


626 


755 


592 


Charenton, 


1825— 1S34 


341 


406 


445 


365 


Mass. State, 


1833—1839 


211 


306 


269 


235 



Total, 1083 1338 1469 1192 

By the evidence of these few statistics, it appears that there 
are more admissions to asylums in summer than in any other 
of the four seasons; but, inasmuch as patients are, in but a 
comparatively small proportion of cases, carried to the asy- 
lums immediately upon the invasion of the disease, it cannot 
be considered as satisfactory in regard to attacks. 

Profession and Occupation. — It is very difficult to deter- 
mine in what particular profession or art, man is most liable 
to mental disease. Could we ascertain the precise ratio of the 
number in each profession to that of the whole population, the 
statistics of the asylums, for a series of years, would throw 
much light upon the subject. Such occupation as requires 
intense mental exercise, or exposes one to sudden changes of 
atmosphere, or to any of the active exciting causes of insanity, 
would, of course, be the most productive of that disease. 

Of 1135 cases treated in American asylums, previously to 
1836, those attributed to physical causes were as follows: 

Intemperance, 146; various bodily diseases, 103; constitu- 
tional, 57; masturbation, 55; hereditary, 40; puerperal, 36; 
typhus fever, 10; repelled eruptions, 9; blows on the head, 7; 
parturition, 6; structural lesion of the brain, 5; excessive 
physical exertion, 4; injuries, 3; epilepsy, 3; insolation, 2; 
injury of nervous centre by falls, 2; inflammation of the brain, 
2; "change from ordinary to vegetable and abstemious diet," 
2; erythema of the brain, 1; malformation, 1; menorrhagia, 
1; suppressed menses, 1; total, 496. 

Hydrocephalus, vertigo, headache, metallic fumes, inani- 
tion, inordinate sexual gratification, severe pain, extremes in 



119 

heat and cold, worms, dropsy, consumption, and the suppres- 
sion of any natural or habitual discharge may be included in 
this class of causes. j 

b Moral Causes. — Religious excitement and anxiety, re- 
verses of fortune, and other pecuniary embarrassments, grief 
for the loss of friends, domestic difficulties, intense mental 
exertion, and disappointed affection and ambition, are the most 
prominent of the exciting moral causes of insanity. 

It is a fact worthy of notice, that of the 1557 cases admitted 
at the Asylum at Charenton, and of which the causes of 1375 
are assigned, not one is attributed to religious doubt, anxiety 
or perplexity. On the other hand, of 678 cases treated at the 
Massachusetts State Lunatic Hospital, no less than 53, equal 
to 7.81 per cent., are stated to have arisen from those causes. 

Ellis, in speaking of the general paucity of cases arising 
from these causes, in continental Europe, accounts for the fact 
by the prevalence of "infidelity among the higher orders/' 
and "ignorance and blind superstitious obedience to the dic- 
tum of the priests, among the lower classes," together with 
the fact that religious discussion is prohibited in some of the 
continental countries. 

The predominating cause of the disease in the patients of 
the Asylums at Wakefield and Hanwell, in England, is po- 
verty and pecuniary difficulty; and, what is a lamentable fea- 
ture in regard to these cases, they are mostly among the 
honest and industrious. These institutions being devoted 
especially to the indigent, it is not remarkable that this cause 
should bear a greater relative proportion, than in asylums erf a 
different character. 

In 1827 it was estimated that of 14,000 lunatics in England 
and Wales, 11,000 of them were in indigent circumstances. 
In the state of New York, in 1S25, of 967 lunatics, 382 were 
supported by charity, 312 possessed the means of subsistence, 
and 273 were unclassified in this respect; and of 1484 idiots, 
514 were supported by charity, 549 supported themselves, 
and 421 were unclassified. In the same state, in 1837, no 
less than 652 lunatics were either relieved or supported by 
charity. 



120 

Grief for the loss of friends is much more productive of 
mental derangement in women than in men; and, in them, the 
origin of the grief is most frequently the loss of children. 

Of the 1135 cases mentioned under the head of physical 
causes, the moral causes, so far as known, were as follows: — 
Religious 70, domestic trouble 60, reverse in fortune and other 
pecuniary difficulties 56, loss of friends 46, mental application 
34, disappointed affection 2S, disappointed ambition 11, "dis- 
appointment" 11, indulgence of temper 8, care and anxiety 7, 
jealousy 5, austere parental government 4, fright 2,, mortified 
pride 1, "agitation on the approach of matrimony" 1, "meta- 
physical hair-splitting" 1, "predisposition excited by novel- 
reading" 1. Total 346. 

Thus it appears that of the 1135 cases, 496 were produced 
by physical causes, 346 by moral causes, and in 220 cases the 
origin was unknown. 

In Europe, it is generally believed that a greater number of 
people become insane from moral than from physical causes* 
The truth of this, if applied to the United States, is doubted, 
although our statistics are not sufficiently complete for a satis- 
factory demonstration. It is extremely difficult for the physi- 
cians of lunatic asylums to ascertain either the proximate or 
the immediate causes of the disease, in many of their patients. 
In some cases it is unknown by the friends of the individual; 
while, in others, although known, a concealment is induced by 
motives of friendship. We submit that, for the facility of the 
physician in obtaining that accurate knowledge of the disease 
upon which, alone, he can establish a rational treatment, as 
well as for the advancement of our knowledge in relation to 
the disease in general, such motives ought to be entirely waived. 

Among the moral causes unenumerated, but mentioned by 
several authors, are avarice, joy, terror, anger, shame, guilt, 
defamation, calumny, ridicule, absence from native country, 
loss of liberty, loss of beauty, love of praise, gaming, and "the 
complete gratification of every wish of the heart." 

Dr. Rush believed that the study of the mechanic and other 
arts is more liable to induce insanity than that of the sciences. 
Among those who have suffered from similar studies, have 



121 

been many who have followed, with a zeal worthy of a better 
cause, that "shadow of a shade," the Utopian perpetual-motion. 
It is said that instances of insane priests, artists, sculptors, 
poets and musicians are numerous, whereas no case is known 
to have occurred among naturalists, geometricans and chemists. 
Further investigations are required before the latter clause of 
this proposition can be received as an established truth. In 
regard to a part of the former clause, it may be mentioned that 
an acquaintance of ours asserts that in order to write poetry a 
person "must be a little crazy." 

Fear has driven people to madness; it has blanched the 
darkest hair in the course of a few hours, and it has proved 
fatal to existence. Ellis relates a painfully interesting case of the 
effect last mentioned, which, as a useful warning, is worthy of 
being known. "A melancholy instance," says he, "of the effect 
of terror happened a few years ago, in the north of England. 
A lady had gone out to pay an evening visit, at which she was 
expected to stay late. The servants took advantage of the 
absence of the family to have a party at the house. The nurse- 
maid, in order to have enjoyment without being disturbed by 
a little girl who was entrusted to her care, and who would not 
remain in bed by herself, determined to frighten her into being 
quiet. For this purpose, she dressed up a figure and placed it 
at the foot of the bed, and told the child if she moved or cried 
it would get her. In the course of the evening the mother's 
mind became so forcibly impressed that something was wrong 
at home, that she could not remain without going to ascertain 
if any thing extraordinary had occurred. She found all the 
servants dancing and in great glee; and, on enquiring for the 
child, was told that she was in bed. She ran up stairs and 
found the figure at the foot of the bed, where it was placed by 
the servant, and her child with its eyes intently fixed upon it, 
but, to her inexpressible horror, quite dead." 

It has been denied that political excitement and changes 
have given rise to insanity. Without reference to other au- 
thority upon the subject, I would adduce the 2S cases men- 
tioned by Esquirol among those who, in 1830 and 1831, were 
admitted into the asylum at Charenton. There had not been 
11 



122 

an individual case of the kind during the four years previous 
to 1S30. Even admitting political causes, abstractly con- 
sidered, to possess no direct tendency to the production of 
insanity, still the consequences which but too often result from 
them, must inevitably exercise a powerful influence to that 
effect. Such are mental anxiety, the loss of property and of 
friends. Who can for a moment doubt that, at the time when 
France was menaced by powerful foes upon every hand; torn 
by dissensions, and bleeding under a civil war; when hundreds 
of princely estates were confiscated, and all the rich were 
compelled to relinquish, not only a tithe, but a third part of 
their wealth, to ^support political movements to which they 
were opposed: when the country was filled with guillotines, 
and whole cities were doomed to destruction; that there was a 
greater tendency to mental alienation than in the time of peace 
and political quietude? The following is an interesting case of 
derangement which occurred during the difficulties alluded to 
in France. It is related by the Viscountess Beauharnais, after- 
wards the Empress Josephine. 

The Abbe Capdeville became interested in an English 
orphan, eight years of age, and took him to educate. The boy, 
who, in the account, is called Tommy, was so kindly treated, 
that he conceived a strong attachment for his benefactor. At 
length, the Abbe was imprisoned in the Carmelites, and Tommy 
obtained permission to be shut up with him. One day, when 
the Abbe and other priests, his fellow prisoners, were at prayers 
in the chapel connected with the building, a mob of revolu- 
tionists broke into the place. Tommy took a station beside 
the kneeling Abbe, and would not remove. "The ruffians 
having forced open the doors, and broken the windows, pene- 
trated by several points at once; the pavement of the chapel, 
and the steps of the sanctuary, were speedily inundated with 
blood. Capdeville, struck immediately after the bishop, fell 
at his feet, and, extending a mangled hand to Tommy, expired 
as he looked upon him. That look was a last blessing. 

"Already the poor youth, or rather child — for he is not yet 
sixteen — exhibited unequivocal symptoms of alienation of 
mind: on the death of his friend, a fixed insanity appeared. 



123 

The unfortunate Abbe, who had knelt apart from his compa- 
nions in martyrdom, having been engaged in officiating, had 
fallen with his head supported on the upper step of the altar, 
and his body extended across the others; the left hand was 
pressed against the heart, and the right, as I have already said, 
extended towards his pupil. The blow which had finally de- 
prived him of life, had been so rapid in its operation, that 
death had not effaced the habitual expression of benevolence 
which lighted his placid countenance. He seemed to smile 
and slumber. By some sudden changes in the reasoning facul- 
ties, Tommy became convinced that his friend slept. Instantly, 
as if by enchantment, the scene of slaughter disappeared from 
before his vision; he knelt down by the side of the bleeding 
corpse, waiting its awaking. After three hours of watching, 
and as the sun sank down below the horizon, Tommy went to 
seek his harp, and again sat down beside the remains of his 
friend, playing melancholy airs in order to hasten his awaking, 
which appeared to him long in taking place. While thus em- 
ployed, sleep stole over his own frame, and the charitable 
hands that removed from the despoilers the bodies of the 
martyrs, carried away Tommy, and laid him on his bed. 
There he remained eight and forty hours in a kind of lethargy, 
whence, however, he awoke with all the appearances of sound- 
ness of body and mind. But, if health had been restored, 
reason had fled forever. 

"In commemoration of his pious madness, a free asylum has 
been granted to him in this house, where he passes the day in 
silence till each afternoon at three o'clock. The moment that 
hour strikes, Tommy, who ordinarily walks slowly, runs to 
seek his harp, upon which, leaning against the ruins of the 
altar still remaining in the chapel, he plays his friend's favour- 
ite, airs. The expression of his countenance, on these occa- 
sions, announces hope; he seems to expect a word of approba- 
tion from him whose remembrance he cherishes: this hope and 
this employment continue until six o'clock, when he leaves off 
abruptly, saying 'Not yet, but to-morrow he will speak to his 
child.' He then kneels down, prays fervently, rises with a 
sigh, and retires softly, upon tiptoe, that he may not disturb 



124 

the imaginary repose of his benefactor. The same affecting 
scene takes place day after day; and, during the intervals, the 
poor boy's faculties seem completely absorbed, till the fatal 
hour calls forth the same hopes, detined forever to be chilled 
by the same disappointment."* 

It is a fact worthy of notice that, as a general rule, insanity 
is but little known in those countries the inhabitants of which 
are either in a savage or a barbarous state of society; whereas 
it prevails to the greatest extent in nations occupying th( 
highest rank in civilization. The celebrated traveller, Baror 
Yon Humboldt, found but few cases among the aborigines oi 
America. It is rare, also, among the negroes of the West In- 
dies. The peasantry of Wales, the natives of the Hebrides, 
and of the most secluded parts of Ireland, are almost entirely 
free from it. It is comparatively infrequent in Spain and Por- 
tugal, although idiocy is very common in those countries. In 
Russia and in China, it is said that it but seldom occurs; but, 
in regard to the British East Indies, Sir Andrew Halliday 
says, "Insanity is a frequent disease among the natives of every 
caste. The attacks are generally sudden and often violent; 
but, under proper medical treatment, they are easily removed." 

In the hospital at Cairo, Egypt, a city of 300,000 inhabi- 
tants, Desgenettes found but fourteen persons afflicted with 
disorders of the brain and the nervous system. In Greece, at 
the present day, there are very few who are insane. There is 
no asylum for their treatment in that country, and there were 
no patients of the kind in the hospitals of Athens in the au- 
tumn of 1838. In Turkey, also, the number of the insane is, 
undoubtedly, very small, although we have no accurate data 
upon the subject. The people of that country are, however, 
to a greater or less extent, exempt from the influence of some 
of the most potent causes of the disease in the United States 
and the nations of the west of Europe. 1st. The Turks are a 
pre-eminently temperate people. 2d. They avoid the sallies 
of uncontrolled passion, and preserve a remarkable degree of 



* Vide Memoirs of the Empress Josephine, by John S. Menres, LL. D. 
Harpers' editioD, p. 88 to 93. 



125 

equanimity of temper. 3d. Reverses of fortune operate less 
powerfully upon them than upon some other people; both be- 
cause a misfortune of that kind is considered as a decree of 
Allah, and because, with a loss of fortune, a person does not 
lose his station in society. 4th. They probably are less affected 
by religious anxiety, doubt and perplexity. The practical 
religion of Mahomet chiefly consists in the observance of cer- 
tain ceremonies, having fulfilled which, the Turk rests satisfied 
that he has performed his duty. It will be perceived that, 
under these four heads, are included three, at least, of the 
most powerful causes of mental derangement. 

We possess but very little accurate knowledge in reference 
to the number of lunatics in different nations. The following 
table, compiled from various authorities, exhibits, in a condensed 
form, the principal data upon the subject. It is extracted from 
a review of Esquirol on Mental Diseases in the American 
Journal of the Medical Sciences. 





Population. 


No. of Insane. 


Proportion. 


England, 


12,700,000 


16,222 


1 in 793 


Scotland, 


2,093,503 


3,652 


" « 563 


France, 


32,000,000 


32,000 


" " 1,000 


Norwaj T , 


1,051,300 


1,909 


" " 551 


Belgium, 


3,816,000 


3,763 


" " 1,014 


Holland, 


2,302,000 


2,300 


" * 1,046 


Italy, 


16,7S9,000 


1,441 


" " 4,879 


Spain, 


4,085,000 


569 


" « 7,181 


United States, 


12,866,020 


16,000 


" " 800 


Westphalia, 


. 


. 


a u 846 


Saxony, 


. 


. 


" " 968 



The following, from the same source, exhibits the similar 
statistics of several large cities. 

Population. No. of Insane. Proportion. 

London, 1,400,000 7,000 1 in 200 

Paris, 890,000 4,000 « " 222 

Petersburg, 377,000 120 " " 3,133 
11* 



126 





Population. 


No. of Insane. 


Proportion. 


Naples, 


370,000 


479 


1 in 759 


Cairo, 


330,000 


14 


" " 30,714 


Madrid, 


204,000 


60 


" " 3,350 


Rome, 


154,000 


320 


'< u 421 


Milan, 


151,000 


618 


u tc 242 


Turin, 


114,000 


331 


" « 344 


Florence, 


30,000 


236 


« " 338 


Dresden, 


70,000 


150 


" " 466 



In a recent work by Professor Vander Kolk, of the Univer- 
sity at Utrecht, it is asserted that there are 1828 lunatics in 
the several provinces of Holland. The population of the same 
territory is 2,253,796; which gives 1233 inhabitants to 1 lu- 
natic. The proportion of insane is small; if it be correct, the 
comparative exemption from the disease may, in part, be attri- 
buted to the general sobriety of the people, and their somewhat 
phlegmatic temperament. 

The population of the islands of Malta and Gozo is 120,000. 
Of this number, 130, or 1 in 920, are insane. In most of the 
New England States, the proportion was formerly believed to 
be about 1 in 1000. More recent investigations have proved 
this estimate to be too low. In the following table are includ- 
ed, with others, the most recent ami accurate estimates that 
have been published in regard to several of the States of the 
American Union. 





Population. 


xso. of Insane. 


Proportion. 


Holland, 


2,253,794 


1,82S 


1 in 1,233 


Malta and Gozo, 


120,000 


130 


u u 920 


New Hampshire, 


280,000 


600 


a u 466 


Massachusetts, 


612,000 


1,000 


« « 612 


Connecticut, 


29S,000 


700 


a « 425 


New York, 


. 


. 


« « S87 


Pennsylvania, 


1,348,233 


2,000 


" " 674 


Virginia, 


1,200,000 


800 


" « 1,500 



127 

In some of these estimates, idiots are included with the in- 
sane; in others they are excluded. 

In Scotland the greatest proportion of insane and idiots is in 
the counties of Perth, Aberdeen, Lanark, Inverness, Nairn, 
Banff, Fife and Kinross, and in the mainland of Argyle and 
the island of Bute. 

In England, the disease is more prevalent in the counties of 
York, Wilts, Stafford, Durham, Rutland and Gloucester, than 
in any other parts of the country. The greatest proportionate 
number of lunatics and idiots is in Rutland, where there is 1 
for every 497 persons; and the smallest number in Lancashire, 
where there is but 1 for every 1960 persons. In Wales the 
number of insane, relative to the whole population, is very 
small. The remark is also applicable to the Celtic tribes in 
other parts of Great Britain; and, where there is a union of 
Celtic with Saxon and Norman blood, the disease is scarcely 
known, except in cases of anormal structure, or malformation 
of the cranium. In these instances the individuals are idiotic. 
We have a remarkable example of endemic idiotism in the 
cretins of some of the cantons of Switzerland. Esquirol asserts 
that, in the southern provinces of France, the number of insane 
men exceeds that of insane women, while the reverse obtains 
in the provinces of the north. 

Duration. — The dur^ion ^of insanity varies from a few 
days, in one extreme, to forty, fifty, and even sixty years in 
the other. The average time is said to be about thirteen and 
a half years, but it cannot fail of being materially diminished 
by the modern enlightened mode of treatment. Individual 
cases may, perchance, be even prolonged; not, however, by 
any injury arising from the treatment, but from a mitigation 
in the severity of the disease by which the day of death is 
postponed. In a memoir presented to the French Institute, 
M. Pinel states that more are cured during the first month of 
the disease than in any one of the succeeding, and that the 
average duration of those that are cured is from five to six 
months. M. Esquirol and S. Tuke give a longer period as 
the mean time of continuation. The former says, that of 2,005 
females admitted at the Salpetriere, Paris, the greatest number 



128 

of cures was effected in the first two years, and that the ave- 
rage was "somewhat short of a year." The probability of a 
recovery after the third year, is considered as about one to 
thirty. "I have constantly observed/' says Dr. Prichard, 
"that in the course of the first month, a very marked remis- 
sion takes place" in the disease. He supposes that at this 
time the acute form of the disease is exchanged for the chronic. 

From these statements we may infer that, if uncomplicated 
with any other functional disease, and unaccompanied by an 
organic lesion of the brain, the natural period of acute mania 
is brief. 

Termination. — Insanity terminates in a restoration to 
health, in fatuity , or in death. 

Curability. — The proportion of cures varies according to 
the age and sex of the patients, the cause of the disease, the 
disorders with which it may be complicated, the treatment, &c. 
&c. The probability of recovery is greater in young than in old 
people. According to M. Esquirol, few recover who are more 
than sixty years of age. The same author asserts that the pro- 
portion of cures is greater in France than in England. To 
demonstrate the truth of this, he collects the statistics of four 
asylums in England and compares them with those of his own 
practice in three asylums of Paris. 

No. of patients. Recovered. Percent. 
Four Asylums in England, 16,516 5918 35.7 

Three " in Paris, 5,360 2691 50.2 

Dr. Burrows denies the truth of the assertion which these 
statistics are intended to prove. 

The proportion of recoveries in various institutions, in both 
the United States and other countries, may be seen in the fol- 
lowing table. 



French Asylums. 


Time. 


No. of 
patients. 


Recover 
ed. 


Perct. 


Charenton, 


From 1798 to 1803 


596 


194 


32.55 


i< 


" 1826 to 1834 


1205 


516 


42.82 


Salpetriere, 


" 1801 to 1813 


3007 


1625 


54.04 


Esquirol's private, 


unknown. 


335 


173 


51.64 



129 



British Asylums. 




Time. 


No. of 
patients. 


Recover 
ed. 


Perct. 


Bethlehem, From 1684 to 1703 


1294 


890 


69.77 


it 


a 


1748 to 1794 


8874 


2557 


28.81 


a 


it 


in 1813 


422 


204 


48.34 


tt 


tt 


1819 to 1833 


2445 


1124 


45.56 


Saint Luke's, 


a 


1751 to 1801 


6458 


2811 


43.52 


Wakefield, 


a 


1819 to 1836 


2242 


991 


44.20 


Lancaster, 


a 


1817 to 1832 


1750 


697 


39.82 


Stafford, 




unknown 


1000 


429 


42.90 


Retreat, near York, 


a 


1796 to 1835 


508 


236 


46.43 


York, at York, 


it 


1815 to 1837 


1131 


387 


34.21 


Cork, Ireland, 




20 years 


1431 


751 


52.48 


Other European Asylt 


ams. 










Amsterdam, Holland, 




2£ years 


163 


56 


34.35 


Utrecht, " 


a 


1832 to 1837 


255 


104 


40.78 


Turin, Italy, 


a 


1827 to 1836 


1066 


466 


45.59 


Aversa, " 


it 


1813 to 1833 


3897 


1514 


38.85 


American Asylums. 












Pennsylvania Hospital, 


tt 


1752 to 1836 


4116 


1349 


32.77 


Frankford, Pennsylvania 


a 
> 


1817 to 1838 


507 


214 


42.21 


ti a 


a 


1838 to 1839 


235 


141 


60.00 


Bloomingdale, N. Y., 


tt 


1821 to 1835 


1915 


828 


43.23 


Bellevue, " 


a 


1791 to 1821 


1553 


704 


45.33 


M'Lean, Mass., 


tt 


1818 to 1834 


1015 


362 


35.66 


Retreat, Conn., 


tt 


1824 to 1839 


1001 


563 


56.24 


Massachusetts state, 


tt 


1833 to 1840 


1196 


506 


42.30 


Maryland, " 


a 


1835 to 1840 


393 


135 


34.35 


Virginia state, Staunton, 


it 


1828 to 1836 


79 


13 


16.45 


tt ti a 


tt 


1836 to 1839 


78 


34 


43.59 


Ohio, state, 


ti 


1839 to 1840 


258 


80 


31.00 



The average per cent., as exhibited by this table, is, for the 
French Asylums, 45.26; for the British, 45.01; the other 
European, 39.89; and for the American, 40.26. 

The difference in the proportion of cures, at the several 
asylums is, in reality, less than appears by this table; for the 
number of patients given is, in some instances, that of all ad- 
mitted; while, in others, it is that of the discharges alone. 
Again, the difference actually existing, is owing, in no incon- 



130 

siderable degree, to the diversity of character in the institu- 
tions themselves. While some of them are intended exclu- 
sively for paupers, and are consequently compelled to admit 
every applicant of that class, of what age, grade or condition 
soever he may be; others have the power of rejecting such 
cases as they please, and restricting their admissions to those of 
a certain character. This difference exists in both Europe and 
America. St. Luke's and Bethlehem Hospitals, in London, 
reject all persons "who have been insane more than a year, 
those affected by paralysis and epilepsy, and the aged and 
feeble." 

It is probable that there is an error in the statistics of Beth- 
lehem Hospital, from 1684 to 1703. If there be not, the 
patients must have recovered in spite of their treatment, or the 
institution must have been far superior to what it was a century 
later. 

Those asylums which have but recently commenced opera- 
tions, suffer much by a comparison with the others, if the per 
cent, of cures is reckoned upon the whole number admitted. 
The Ohio State Lunatic Asylum furnishes an example of this 
kind. The number (258) in the table, is that of all the patients 
admitted. The per cent, of cures, upon these, is only 31; 
while, if calculated upon the discharges, it would have been 
66.66. 

It was left for the physicians of the present age to demon- 
strate, that as great a proportion of patients suffering under 
acute mania may be cured as of those of any other acute 
disease. This has been satisfactorily proved. A great remiss- 
ness, however, exists upon the part of the friends of this 
unfortunate class of the community, in neglecting to place them 
in a hospital during the earliest stages of the malady. "It fre- 
quently happens," says the eighteenth report of the Asylum at 
Frankford, Pennsylvania, "that applications for admission into 
our asylum are not made until after the most promising period 
for recovery has elapsed." Similar complaints are urged in 
the reports of other hospitals. 



Per ct. of cures 


Per ct. of cures 


in recent cases. 


in chronic cases. 


91.32 


35.18 


89. 


28.02 


8S.20 


28.05 


87.25 


19.05 


91.25 


22.05 


85.50 


41.17 


83.87 


25.39 


75.95 




91.60 


25.83 



131 

The following table exhibits the advantage of early treat- 
ment. 

Asylums. Time. 
Dr. Burrows', 

Vermont State, 3 years 

<< " 1840 

Massachusetts State, 1833 to 1840 

" " in 1840 

Ohio State, 1839 & 1840 

Bloomingdale, in 1S39 

Retreat, Conn., 6 years 

" " 4 years 

The average per cent, of the recent cases is 87.10, while 
that of the chronic cases is but 28.28. The term "recent" is 
generally applied to all cases of less than one year in duration, 
and "chronic" to all others. This signification of the terms 
is recognised in all the above mentioned asylums, excepting 
the Connecticut Retreat. In that institution I think the term 
"recent" is restricted to cases of less than three months dura- 
tion. 

A large majority of recoveries are complete and permanent, 
others are apparently complete, but the patient remains in a 
condition from which he may very easily relapse, if exposed 
to exciting causes. In many cases of perfect restoration to 
physical health and energy, the persons are incapable of sus- 
taining their former intellectual rank. Diseases of the nervous 
system are peculiarly liable to relapses. When the integrity 
of this dynamic apparatus has been destroyed, it is restored 
with more difficulty than is that of any of the other systems 
of organs in the human economy. Pinel and Desportes state 
the proportion of relapses at one-sixth the number of original 
cases; at the Salpetriere it was one-seventh. 

Fatuity. — The state of patients whose disease has had this 
unfortunate termination, is different from that of idiots, or of 
those who are in the imbecility sometimes attendant upon old 
age. Dr. Prichard divides fatuity into two grades, 1st, De- 
mentia, and 2d, Amentia. 



132 

1st. Dementia. This is the "d&mence" of M. Esquirol and 
Georget, and is that state in which the physical and mental 
powers have become overpowered or exhausted by the force 
of the disease. From an intense excitement the patient relaxes 
into a state of quietude, ominous of a decay of mental vigour; 
memory is obliterated, the patient becomes inactive, thought- 
less, unobserving, and perhaps utters 

"A hollow laugh or melancholy song," — 

the former a painful evidence of mental vacuity and imbecility, 
the latter, as it were, a requiem over the departed powers of 
that spirit which alone elevates man above "the brutes that 
perish. " Some appear to recollect their friends, but all affec- 
tion for them is annihilated. Some are capable of performing 
light manual labour, others are not. Physical health is gene- 
rally good, digestion and assimilation being unimpaired. A 
few instances of recovery are on record. 

2nd. Amentia. We have here arrived at the most abject 
state of mental imbecility. Reason, entirely dethroned, has 
left no trace of her once having occupied the palace which she 
has deserted. Man, "the lord of the universe," entirely di- 
vested of his mental and moral energies, becomes a mere vital 
automaton, moving by the force of its organic life, and directed 
by the capricious impulse of the moment. Many patients in 
this state remain motionless, perchance, during the day, their 
eyes fixed upon the ground, as if unconscious of the things or 
persons around them, or even of their own existence. They 
would not retire to bed nor rise were they not forced to do it 
by their attendants. 

3d. Death. "Madness," says Prichard, "cannot be reckon- 
ed among the diseases which are very dangerous to life." But 
if, as he declares in another place, "lunatics are subject, in a 
much greater proportion than other people, to apoplexy, 
paralysis, epilepsy, and all the train of symptoms depending 
on different degrees of cerebral congestion;" if, as is the fact, 
acute insanity produces great exhaustion and prostration of 
physical energy, and if "diseases of the thoracic and abdominal 
viscera, and a cachectic or scorbutic state of the system" be its 



133 



sequelae, then must he, and every other person, acknowledge 
that if not "very" it is somewhat "dangerous to life." The 
following table exhibits the ratio of deaths to the number of 
patients in several asylums. 



Asylums. 


Time. No. 


of patients. 


Deaths. 


Per ct. 


Hanwell, England, 


From 1832 to 1837 


3327 


418 


12.56 


Lancaster, " 


» 1832 to 1837 


2148 


522 


24.29 


Wakefield, " 


" 1818 to 1836 


2242 


709 


31.64 


York, 


" 1777 to 1814 


2635 


399 


16.80 


tc it 


» 1815 to 1837 


1131 


217 


19.27 


Retreat, York, " 


» 1796 to 1836 


508 


113 


22.22 


Charenton, France, 


» 1826 to 1833 


2049 


546 


26.64 


Salpetriere, " 


" 1801 to 1804 


1002 


250 


4.95 


a it 


" 1805 to 1813 


2804 


790 


28.17 


Bicetre, " 


" 1784 to 1794 


1405 


685 


48.75 


Aversa, Italy, 


" in 20 years 


3897 


1222 


31.35 


Amsterdam, Holland, 


" 1832 to 1837 


255 


55 


21.56 


Penna. Hospital, U. States, " 1752 to 1836 


4116 


548 


13.31 


Bellevue, N. Y. 


•' " 1791 to 1821 


1553 


154 


9.91 


Bloomingdale, " 


' " 1821 to 1835 


1915 


146 


7.62 


Frankford, Pa. 


» " 1817 to 1838 


634 


90 


14.19 


Maryland State, 


' " 1835 to 1839 


393 


34 


8.65 


Retreat, Connecticut, 


< " 1824 to 1839 


1001 


60 


5.99 


Massachusetts State, 


■ " 1833 to 1840 


1196 


90 


7.50 


Ohio State, ' 


4 " 1839 to 1840 


258 


22 


8.52 


Kentucky State, 


" 1824 to 1838 


627 


238 


37.95 



The average of the deaths in the British Asylums is 21.13 
per cent.; in the French 32.12 per cent; in the American 
12.62 per cent; in the American, rejecting the Kentucky State 
Asylum, 9.33 per cent. 

Among the immediate causes of death other than insanity 
itself, the following diseases are reported as being the most 
numerous, viz: — Apoplexy, paralysis, epilepsy, phrenitis, con- 
vulsions, tumour of the brain, phthisis pulmonalis, pleurisy, 
pneumonia, hydrothorax, organic affection of the heart, hydrops 
pericardii, gastritis, schirrus of the pylorus, organic lesions of 
the liver, diarrhoea, typhus fever and marasmus. It is evident 
that the insane are equally liable with others to the invasion of 
most of the diseases which afflict mankind. 
12 



134 

Treatment. — The treatment of insanity is divided into, 1st, 
medical, and 2d, moral. Of the former nothing will here be 
introduced; the latter alone will receive attention. 

Among the many benevolent institutions which have origi- 
nated as almost legitimate consequences of superior civilization, 
more extensive and widely diffused knowledge, and a more 
enlightened philanthropy, not the least beneficial in their re- 
sults are those which have for their object the amelioration of 
the condition of the insane. Formerly, the unfortunate indi- 
vidual subject to maniacal hallucination was supposed to have 
violated the laws of heaven, and thus incurred the displeasure of 
a Creator, the phials of whose wrath were consequently poured 
out, in this form, upon the offender. But the sentiments of 
the community have changed. The lunatic is no longer "a 
reproach and a bye-word," his family are no longer shunned as 
being partially implicated in his unknown offence; but, as a 
sufferer under one of the most afflicting maladies to which our 
race is subject, the former receives that kindness and attention 
which the human heart, alive to the sufferings of our fellows, 
so well knows how to bestow, while the latter partakes of the 
fountain of sympathy gushing from a thousand bosoms. The 
sufferings to which maniacs were formerly, and, in too many 
instances, still are, subjected, sufferings which place recovery 
beyond hope, their imprisonment and confinement in dungeons, 
their tortures under manacles and chains, their deprivation of 
food, of clothing, and of all the comforts of life, are such that 
we are almost struck with horror at their recital. The noble 
philanthropist, M. Pinel, to whose untiring exertions the luna- 
tics of France are indebted for an amelioration of their condi- 
tion, has given a thrilling description of the vast accumulation 
of misery, which, during his investigations, was presented to 
his view. In England and Scotland, although some hospitals 
existed, the wretchedness and inhumanity, were, according to 
Halliday, previously to 1S15, equally great. In "Bedlam," 
or Bethlehem Hospital, in London, at that time, the patients, 
"as wild beasts, were shown for sixpence for each person ad- 
mitted." 

A fundamental error formerly existed with regard to the 



135 

nature of insanity; it was believed that the mind is itself dis- 
eased, instead of the organ through which it is manifested. 
But disease is the minister of death, and the mind, a scintilla- 
tion from the fire of Heaven, being free from the power of the 
latter, is consequently exempted from the encroachments of 
the former. It is, therefore, now acknowledged that insanity 
is produced by a cerebral lesion, and that, too, generally of a 
functional nature; it necessarily follows that the disease is 
within the reach of remedial agents. But chains and a dun- 
geon are miserable prescriptions to a pathological state of the 
most delicate organ of the human frame, an organ which is 
called constantly into action by an invisible, but powerful and 
controlling agency. Experience has fully attested the truth 
of this assertion. It has also proved that, mild and gentle 
means, pleasing amusements, light labour, and affectionate 
treatment, by those around the patient,are powerful auxiliaries 
in promoting a cure. Since this has been demonstrated, the 
number of Lunatic Asylums has greatly increased, for, in those 
institutions, the system of treatment can be more completely 
adopted than in most private families. England, Scotland, 
Ireland, and most of the countries of continental Europe are 
supplied to a greater or less extent with these institutions, and 
there are several of the kind in Southern Asia. Our country 
has caught the spirit, and is imitating the good example of her 
transatlantic sisters. Already we have no less than seventeen 
Lunatic Asylums in operation. In these, or in such of them 
as are of the most approved construction, the patients are clas- 
sified according to the degree of their mental alienation, thus 
making three divisions; 1st, those in whom the disease is vio- 
lent and unabated; 2d, the milder and the convalescing; and 
3d, the convalescent. The individuals of each class occupy a 
suit of rooms communicating with each other by a common 
hall, and also with a yard in which they are permitted to ex- 
ercise at suitable hours. The different classes have no com- 
munication with each other. The patients are treated medi- 
cally whenever such treatment is necessary; but, as in the 
European asylums, the management of all cases, indiscrimi- 
nately, in this manner, has been abolished. The physician 



136 

now endeavours "to combine moral and medical treatment, 
founded on the principles of mental philosophy and physi- 
ology." Hence, in many cases, a simple, but wholesome and 
nutritious diet has supplanted the long category of medicines 
which have sometimes been employed. 

It is now conceded by all who are best acquainted with the 
management of the insane, that the first element in their mo- 
ral treatment is their removal from acquaintances and former 
associations. One prominent advantage in such removal is the 
promotion of the second element of treatment, that of with- 
drawing the mind from its hallucinations, and attracting it 
into a new current of thought. For the full accomplishment, 
however, of this latter object, after the removal to a suitable 
place has been made, the almost unremitting attention of judi- 
cious caretakers is required. New objects must be presented 
to the view, new incentives to the mind, and no expedient 
which would be likely to attract the attention and divert the 
thoughts must be left untried. Hence, in those institutions for 
the treatment of this disease which have recently been estab- 
lished, as well as those older establishments which have kept 
pace with the progress of knowledge, manual labour, in many 
of its forms, amusements, and sources of literary and scien- 
tific entertainment and instruction, have been introduced among 
the patients. In short, instead of being degraded to a level 
not only with criminals, but with the brute creation, and con- 
sequently shut out from association with mankind, and placed 
beyond the influence of kindness and of sympathy, the insane 
are now treated as intelligent and immortal beings, the affec- 
tions and sympathies of whose hearts are still alive to the in- 
fluences which operate upon those of mankind in general. 

Labour. — "We have seen," says one of the reports of the 
M'Lean Asylum, Massachusetts, "the very best results from 
labour. Patients who, without it, were noisy and trouble- 
some, have become quiet with it. One patient, who was 
brought to the institution in irons, and who, until employed, 
was constantly raving and excited, when furnished with occu- 
pation became quiet." At the Massachusetts State Lunatic 
Hospital, in 1839, no less than one hundred and seventy-nine 



137 

patients were employed in manual labour. The superinten- 
dent of that institution says, in his seventh report: "Of the 
benefit of labour, both for the curable and incurable insane, we 
have been long impressed. It promotes health, induces sleep, 
favours self-control, satisfies the individual of the confidence 
reposed in him by the officers of the institution, and produces 
quiet and contentment." 

At the Pennsylvania Hospital, the Asylums at Frankford, 
New York and Hartford, and at the state institutions of Maine, 
Vermont, Maryland, Virginia and Ohio, the patients are in- 
duced to labour; and testimonies in favour of the utility of the 
practice might be adduced from nearly all of them. 

In Europe similar sentiments prevail. "As employment," 
says Sir Andrew Halliday, speaking of the patients of the Ar- 
magh Asylum, Ireland, "is now generally allowed to be the 
best restorative, every means has been used to promote it. 
Such as are at all capable among the females are constantly 
employed in plain work, spinning, &c; and the division in 
which this is going on is remarkable for its regularity and 
cheerfulness." At the Middlesex County Lunatic Asylum, at 
Hanwell, England, in 1837, of 600 patients, more than 400 
were constantly engaged in some useful occupation. 

In reference to this element of moral treatment, Samuel 
Tuke remarks, "The employment should, as far as it is prac- 
ticable, be adapted to their (the patients') previous habits, in- 
clinations and capacities." He prefers that in which the indi- 
viduals will excel, and the useful rather than amusing, as 
affording to the patient "a calm feeling of satisfaction." "It 
is related," says the same author, "of an institution in Spain, 
which accommodated all ranks, and in which the lower classes 
were usually employed, that a great proportion of these reco- 
vered, while the number of grandees (that recovered) was ex- 
ceedingly small." 

M. Brierre de Boismont, in a recent work, speaking of the 
patients at the Bicetre, Paris, says, "The convalescent maniacs 
have this year excavated large quantities of earth: they have 
engaged with pleasure in farming, and have kept a laundry in 
operation. More than one hundred and fifty of them are 
12* 



138 

employed in throwing up terraces, in masonry, gardening, the 
manufacture of locks, making plaster, cabinet-making and car- 
pentry." Dr. Ferrus, who has long had the medical charge 
of the patients in the Bicetre, in speaking of labour, says, "I 
have made, myself, on a large scale, a happy experiment of its 
efficacy as a means of both discipline and cure. The recove- 
ries have been more rapid, and the relapses more rare." 
Similar testimony might be adduced from the Asylum of Son- 
nenstein in Prussia; from those of Turin and Milan, in Italy, 
and from various institutions of the kind in France and Great 
Britain. 

It is a remarkable fact that, although farming implements 
and edged tools have, for many years, been entrusted to the 
insane, there is not a single instance on record of any serious 
injury having arisen therefrom. 

Religious Worship. — Some of the asylums of both Europe 
and America have a regular chaplain connected with them; 
while, in others, religious services are performed under the 
direction of clergymen who volunteer their services. There 
are but four institutions, in this country, in which there is not 
some religious devotional exercise; and, wherever this duty 
has been observed, it has been accompanied by beneficial re- 
sults. "Regular religious teaching," says Dr. Woodward, "is 
as necessary and beneficial to the insane as to the rational 
mind: in a large proportion of the cases it will have equal in- 
fluence. They as well know their imperfections, if they will 
not admit their delusions; and they feel the importance of 
good conduct, to secure the confidence and esteem of those 
whose good opinion they value." 

Dr. Bell, of the M'Lean Asylum, says, "The regulated, 
discriminating and cautious attention to the exercises of reli- 
gion, is so valuable an auxiliary to the moral means of treating 
diseased mind, not less from its specific influences on the heart 
and feelings, than of its administering to the self-control of the 
individual, that we have rejoiced to see the experience of this 
institution adopted into others." 

Dr. Rockwell, of the Vermont State Asylum, remarks, that 
"much of the good effect of religious worship depends upon 



139 

the prudence and discretion with which it is managed. We 
consider the judicious employment of religious exercises an 
important part of our moral treatment. They serve to pro- 
mote order, revive former grateful habits and associations, and 
recall into exercise that self-control which tends to their reco- 
very. That religion which breathes peace on earth and good- 
will to men, and whose cheering influences extend beyond the 
grave, affords solace and consolation to the insane, as well as 
comfort to the rational mind." 

Dr. Awl, of the Ohio State Asylum, observes, "We are 
fully prepared to add our testimony to the importance and 
value of religious exercises, with the insane, as a special means 
of grace, well calculated to bring light and wisdom to the 
mind, relief and peace to the heart and conscience." 

Amusements. — It is universally acknowledged that suitable 
amusements are efficacious adjuvants in restoring the excited 
and deluded minds of the insane to their healthy standard of 
calmness and accuracy of perception. Hence, in nearly every 
asylum, whether foreign or domestic, the means are furnished 
by which the patients may engage in a diversity of games. 
Entertainment is afforded by an occasional tea-party or dancing- 
party, and the means of intellectual gratification and instruc- 
tion are supplied by books, newspapers and magazines. Those 
patients who have a particular taste or predilection for any 
special science, or in whom such taste can be awakened, ought 
to be supplied with the means of pursuing it. At the Frank- 
ford Asylum, during the past year, a gentleman who had been 
several months under medical treatment, became, by an inci- 
dental circumstance, interested in botany. He immediately 
commenced the study of it, devoting himself with the most 
untiring assiduity to the pursuit. Books, and a microscope to 
facilitate in the analysis of flowers, were furnished him, and 
he was permitted to ramble alone through the woods and 
fields, for the purpose of collecting specimens. He improved 
very rapidly in both physical and mental health, and soon 
returned to his home perfectly restored. 

Music has been tried as a curative means in many Asylums. 
We should suppose, a priori, that it might be attended with 



140 

beneficial results. In order, however, that this should obtain, 
it must be managed with a most discriminating judgment. It 
must be adapted to each patient, according as he is depressed 
or exalted; otherwise, the melancholy in the former case might 
be augmented, and the exaltation, in the latter, increased to 
fury. Esquirol, whose experience in this respect is undoubtedly 
greater than that of any other person now living, remarks, "I 
have tried it (music) in every manner, and under circumstances 
the most favourable to success. Sometimes it has irritated the 
patient even to fury; often it has tended to divert the atten- 
tion, but / cannot say that it has contributed to a cure. It 
has been advantageous to the convalescent." 

"Having made so many partial applications of music, I was 
desirous of attempting it upon many persons, simultaneously. 
My experiments were made during the summer of 1824, and 
that of 1825. Many distinguished musicians of the capital, 
seconded by the students of the Conservatory of Music, as- 
sembled at our Asylum (La Salpetriere) many Sabbath-days in 
succession. The harp, the piano, the violin, some wind instru- 
ments, and some excellent voices, combined to render our con- 
certs as agreeable as interesting. 

"Eighty insane women, chosen by me from the convales- 
cents, the maniacs, the tranquil monomaniacs, and some lype- 
maniacs, were commodiously seated, facing the musicians, in 
the dormitory of the convalescents. * * * * Airs of all 
kinds, of all metres, and upon all keys, were played and sung, 
varying the number and the nature of the instruments. Some 
great pieces of music were also executed. My patients were 
very attentive, their countenances became animated, the eyes 
of many beamed with additional brilliancy, but all remained 
tranquil. Some tears were shed. Two of the patients asked 
permission to sing an air, and to be accompanied: the request 
was granted. 

"This novel spectacle was not without influence upon our 
unhappy patients, but we obtained no cure, not even an ame- 
lioration of their mental condition. After these concerts, 
each of which lasted two hours, the musicians went into the 
apartment among the patients and executed, upon wind instru- 



141 

ments, various well-known popular airs, of a martial or senti- 
mental character. A great number of the women became 
excited, exalted at the sound of the instruments, and many, 
among the furious, formed circles in order to dance. This 
excitement was transient, and passed off almost as soon as the 
music ceased." 

After some further observations, the author finally concludes, 
"If music does not cure, it diverts, and consequently soothes. 
It produces some alleviation, both physical and moral; it is 
evidently useful to the convalescent, and consequently it is not 
necessary to discontinue its use." 

The human mind is prone to extremes, as the musical chord, 
which, if deviated from the line of tension, recoils to nearly 
the same extent upon the opposite side. And, to pursue the 
simile, the harmony of the former, like that of the latter, is 
the most agreeable when those extremes are least. The most 
intimate friend, if once estranged, is liable to become the most 
implacable enemy. Some physicians, discarding the antiphlo- 
gistic, adopt the ever stimulant method of treatment; and 
others, once accustomed to drugging their patients to a most 
liberal extent, reject this practice and adopt the infinitessimal 
principles of homoeopathy. Governments fall from despotism 
into anarchy, and from anarchy return to despotism. In the 
modern laudable crusade against distilled spirits, some of the 
leaders in the cause, the hermit-Peters of the warfare, have 
banished not only spirits, wine and fermented liquors, but tea, 
coffee, meat and condiments, by their code of dietetics. In 
all these instances, perhaps, there is a "golden mean," which 
is better and wiser than either extreme. In the moral treat- 
ment of insanity care is required, lest, in the recoil from the 
barbarity of former times, the opposite error be not avoided. 

These remarks have been suggested by the account given by 
Esquirol of the introduction of theatrical entertainments at 
Charenton. This was done about the year 1805, and continued 
until 1811. A theatre was constructed, comedies, operas and 
dramas were enacted, and, occasionally, fire-works were dis- 
played. "Every body was pleased with it; great and small, 
wise and ignorant, were desirous of being at the exhibition 



142 

given by the lunatics of Charenton. All Paris flocked there 
for several years; some from curiosity, others to judge of the 
prodigious effects of this admirable means of curing the insane. 
The truth is, this means effected no cure. * * * Those 
who were to witness the exhibition were selected by favour. 
This excited jealousies, quarrels, and bitterness of feeling. 
Hence occurred sudden explosions of delirium and returns of 
mania and of fury. * * * That which passed at Charen- 
ton teaches us sufficiently upon this subject. How many were 
the relapses, how numerous the paroxysms of fury, provoked 
by these theatrical representations! Never have we seen pa- 
tients cured by this mode of treatment." 

Since the foregoing remarks were written, a treatise upon. 
Insanity has appeared in Paris, the object of which is "to 
establish the truth of the following three propositions: — 

1. If it be true that insanity depends on an alteration, or 
morbid condition of the encephalon, we are completely igno- 
rant in what this alteration consists. 

2. The moral treatment of the insane, as usually practised, 
is considered only as an auxiliary of the physical treatment. 

3. In the insane, the intellect and passions cannot be brought 
back to their healthy type, or standard, without the aid of 
moral treatment; and this mode of treatment is the only 

ONE WHICH HAS A DIRECT INFLUENCE ON THE SYMPTOMS OF 
INSANITY."* 

The author of this work is a highly intellectual and scienti- 
fic physician, and his experience in the treatment of the insane 
has been very extensive; hence, his opinions merit attention 
and respect. Those best acquainted with mental diseases, and 
with their present mode of treatment, will acknowledge an 
affirmative to the first two propositions, even without an inves- 
tigation of the arguments adduced in the demonstration of the 
truth of them. But, it is believed that the same assent cannot 
be granted to the sentiment of the latter clause of the third 
proposition. Insanity is far from being an invariably idiopathic 
disease of the encephalon; it is frequently symptomatic of 

* Du Traitement Morale de la Folic. Par F. Leurct, Paris. 1840. 



'\?W 



9 \^ 



143 

affections of the other viscera. Now, we would ask, what is 
that moral treatment, so potent in its influence as to correct the 
morbid conditions of the portal circle, or restore the dyspeptic 
stomach to its normal state? It is to be feared that this author 
has fallen into the extreme alluded to above. 

Attendants. — How perfect soever may be an asylum in its 
organization and administration, how complete soever it may 
be in all the physical comforts which wealth may purchase or 
ingenuity invent, how diverse soever may be the means of 
recreation and amusement — the great object for which these 
have been furnished, that of effecting a cure in the patients, 
will be tardily, if indeed it be ever accomplished, unless the 
attendants, those who have the immediate care of those pa- 
tients, are of a suitable character. Complete dominion over 
the passions, a well cultivated mind, unyielding firmness, un- 
tiring energy, and an ever-watchful vigilance, united with 
mildness, gentleness, an affable and respectful deportment, and 
a benevolent, sympathising, christian mind, are necessary to 
constitute the perfect attendant. The nearer this standard be 
approached, the better will be the care extended to the pa- 
tients, and the more rapid will be the cures. "We will not/' 
says one of the reports of the M'Lean Asylum, "continue any 
male or female attendant, whom we cannot invite into our 
family and seat at our table; and with whom we could not 
confidently place our wives, sisters and brothers." The rule 
that immediate dismissal shall be the penalty of striking a pa- 
tient, is adopted in most asylums, and should be in all. Could 
the standard which we have mentioned be reached, perhaps no 
such rule would be necessary. 

Coercion and Punishment. — The strait-jacket, manacles, and 
chains have nearly been abandoned in the best institutions of the 
treatment of lunatics. The first, however, is still used occasion- 
ally in some of the British Asylums, and is not entirely aban- 
doned in some of those of the United States. A change of loca- 
tion, the deprivation of a privilege, the shower-bath, and other 
punishments comparatively mild, are often sufficiently effective. 
The "tranquillizing chair," and mits and muffs, are still em- 
ployed occasionally in nearly all asylums. In the Connecticut 



144 

Retreat, as says one of the reports of that institution, "in case 
coercion and confinement become necessary, it is impressed 
upon his (the patient's) mind, that this is not done for the 
purpose of punishment, but for his own safety and that of his 
keepers." "In no case," says the same report, "is deception 
of the patient employed or allowed; on the contrary, the 
greatest frankness as well as kindness, forms a part of the 
moral treatment. His case is explained to him, and he is 
made to understand, as far as possible, the reasons why the 
treatment to which he is subjected has become necessary. By 
this course of intellectual management, it has been found, as a 
matter of experience, at our institution, that patients who had 
always been raving when confined without being told the rea- 
son, and refractory when commanded, instead of being en- 
treated, soon became peaceful and docile." Sir A. Halliday 
insists upon the necessity of honourable and candid dealing 
with the insane, and urges the importance of the fact, that they 
are generally, if not universally, affected by kindness, while 
they never forget injuries, insults, duplicity or imposition. 
An appeal to the sympathies of the most maniacal patients, 
while, at the same time, a negative assent is given to their 
particular hallucination, is sometimes more effective than pun- 
ishment. An interesting instance of this kind is related by 
the late Dr. Rush, of a lunatic in the Pennsylvania Hospital. 
This patient having frequently attempted to set fire to the 
building, was expostulated with by one of the managers, who 
endeavoured to impress upon his mind the effects of a confla- 
gration, such as he had attempted. "But I am a salamander," 
said he. "Recollect, however," answered the gentleman ex- 
postulating with him, "'that all the patients in the hospital are 
not salamanders." This sagacious reply had the desired effect; 
the patient desisted from his incendiary attempts. 






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